Academic journal article The Israel Journal of Psychiatry and Related Sciences

Suicide during Clozapine Treatment: A Case Report

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Suicide during Clozapine Treatment: A Case Report

Article excerpt

Abstract: The risk of suicide among patients with schizophrenia is greater than that in the general population. Although clozapine, along with its other significant features, has been reported to decrease suicidality and suicide rate among schizophrenia patients, physicians should remain vigilant for general risk factors of suicide in patients with schizophrenia during a treatment course and assess them carefully. Awareness of the effect of the illness, a sense of inadequacy to achieve goals, a change in the course of the illness, an improvement after relapse and a proposed discharge from the hospital in the near future are factors that should be noted especially within these general risk factors for suicide. In this case report, we presented a schizophrenia patient with several risk factors who committed suicide during clozapine treatment. Risk factors prominent in this case including increased awareness after improvement in chronic state, planned discharge in the near future, and the notion of reduced suicidality in schizophrenia patients during clozapine treatment are discussed in this article based on the literature and the case.

Introduction

Suicidal ideation, suicide plans, attempted and completed suicide occur frequently in patients with schizophrenia (1). The risk of suicide among patients with schizophrenia is 20 to 50 times greater than in the general population (1). About 50% of all patients with schizophrenia attempt suicide, and 10 to 15% of schizophrenia patients die by suicide. The suicide rate in patients with schizophrenia has been reported to be 0.4% to 1.0% per year (2, 3, 4).

There are several risk factors defined for suicide among patients with schizophrenia. These are young age, male sex, single marital status, college education, a previous suicide attempt, a vulnerability to depressive symptoms, especially hopelessness, and a recent discharge from a hospital. Awareness of the effects of illness, a sense of inadequacy to achieve goals, and fear of further mental deterioration are additional important risk factors (3, 5). The use of antipsychotic medications has often been cited as contributing to suicides among patients with schizophrenia by removing psychotic symptoms prematurely, increasing depression and falsely suggesting stable improvements. This contention has not been confirmed by well-designed studies (2). Nevertheless, schizophrenia patients who have persistent and severe positive and negative symptoms, like treatment-resistant and treatment-intolerant cases, might be expected to feel hopeless and to be at particularly high risk for suicide (1, 4).

Clozapine is a novel antipsychotic drug in the treatment of schizophrenia patients who are resistant or intolerant to conventional antipsychotics (3, 5). Contrary to other conventional antipsychotics, clozapine works via a mechanism other than high dopamine-2 (132) receptor occupancy. Clozapine has a low potential for D2 receptor antagonism. However, it has a much higher potency as an antagonist at D1, D4, serotonin type 2 (5-HT2), and noradrenergic alpha-receptors (6). This mechanism of action makes clozapine an effective antipsychotic drug that is associated with significantly fewer parkinsonianlike side effects than are the conventional antipsychotics. Also clozapine appears to be the first antipsychotic drug that has a substantially lower risk of causing extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). The literature reveals very low rates of EPS and virtually no TD in clozapine patients (7, 8, 9). Additional to these unique features, clozapine is found to cause decreased suicidality in neuroleptic-- resistant or intolerant patients. Clozapine is reported to have significant antidepressant effect, which is possibly achieved by normalizing serotonergic function (10). This effect, along with the absence of EPS and TD, the improvement in psychosis, and the increase in cognitive ability, are said to lead to a decrease in suicidality (1, 3, 6). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.