Suicide in Schizophrenia: Risk Factors and Clozapine Treatment

Suicide is the major cause of premature death in patients with schizophrenia. Among these patients,40% report suicidal thoughts, 20% to 40% make unsuccessful suicide attempts, and 9% to 13%end their lives by suicide. Traditional antipsychotic drugs undertreat many schizophrenic patients andcan produce serious side effects, such as tardive dyskinesia. Clozapine is the only antipsychotic drugthat has been shown in controlled clinical trials to be effective in reducing both positive and negativesymptoms in schizophrenic patients who fail to respond to typical neuroleptic drugs. The potentialdecrease in suicide among schizophrenic patients treated with clozapine is estimated to be as high as85%. Treatment with clozapine is cost-effective, and the significant decrease in the risk of suicide faroutweighs the very low risk of mortality from agranulocytosis. Clozapine should be considered fortreatment of both neuroleptic-resistant and neuroleptic-responsive schizophrenic patients who havepersistent suicidal thoughts or behavior.