Effectiveness of Antipsychotics in Reducing Suicidal Ideation: Possible Physiologic Mechanisms.

Nasia Dai,Nunzio Di Nunno,Vincenzo De Luca,Ines Villano,Marcellino Monda,Ahmed Hassan,Alessio Asmundo

doi:10.3390/healthcare9040389

Abstract

Background: The aim of this study is to evaluate whether any specific antipsychotic regimen or dosage is effective in managing suicidal ideation in schizophrenia. Four comparisons were conducted between: (1) clozapine and other antipsychotics; (2) long-acting injectable and oral antipsychotics; (3) atypical and typical antipsychotics; (4) antipsychotics augmented with antidepressants and antipsychotic treatment without antidepressant augmentation. Methods: We recruited 103 participants diagnosed with schizophrenia spectrum disorders. Participants were followed for at least six months. The Beck Scale for Suicidal Ideation (BSS) was used to assess the severity of suicidal ideation at each visit. We performed a multiple linear regression model controlling for BSS score at study entry and other confounding variables to predict the change in the BSS scores between two visits. Results: Overall, there were 28 subjects treated with clozapine (27.2%), and 21 subjects with depot antipsychotics (20.4%). In our sample, 30 subjects experienced some suicidal ideation at study entry. When considering the entire sample, there was a statistically significant decrease in suicidal ideation severity in the follow-up visit compared to the study entry visit (p = 0.043). Conclusions: To conclude, our preliminary analysis implies that antipsychotics are effective in controlling suicidal ideation in schizophrenia patients, but no difference was found among alternative antipsychotics’ classes or dosages.

Highlights

The aim of this study is to evaluate whether any specific antipsychotic regimen or dosage is effective in managing suicidal ideation in schizophrenia
In our sample 17.4% of the participants were on clozapine (n = 28); 3% were prescribed loxapine (n = 3); 26.2% were on olanzapine (n = 27); 3% were on fluphenazine (n = 3); 3% were on quetiapine (n = 3); 17.5% were on risperidone (n = 18); 4% ziprasidone (n = 4); 5% were on zuclopenthixol (n = 5); and the remaining participants were on other antipsychotics
Eight percent of the subjects who were receiving long-acting injectable antipsychotics were on polypharmacy and six percent of participants using oral antipsychotics, other than clozapine, were on polypharmacy

Summary

Introduction

The aim of this study is to evaluate whether any specific antipsychotic regimen or dosage is effective in managing suicidal ideation in schizophrenia. When considering the entire sample, there was a statistically significant decrease in suicidal ideation severity in the follow-up visit compared to the study entry visit (p = 0.043). Conclusions: To conclude, our preliminary analysis implies that antipsychotics are effective in controlling suicidal ideation in schizophrenia patients, but no difference was found among alternative antipsychotics’ classes or dosages. In a large cross-sectional study, participants who had psychosis and reported suicidal ideation were 3.5 times at higher risk to attempt suicide compared to people with suicidal ideation but without psychosis [8]. Several demographic and clinical features seem to be associated with suicide such as male gender, young age, higher level of education, presence of depressive symptoms, past suicide attempts and family history of suicide [6,9,10,11,12,13,14,15]

Objectives

Methods

Results

Discussion

Conclusion