Bipolar pharmacotherapy and suicidal behavior. Part 3: Impact of antipsychotics

Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles 10111 Plummer Street, North Hills, CA 91343, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 11/2007; 103(1-3):23-8. DOI: 10.1016/j.jad.2007.05.018
Source: PubMed


Antipsychotics, particularly second generation agents, are widely used in bipolar disorder, but their effect on suicidal behavior in this population has not been systematically studied.
Retrospective chart review of 405 veterans with bipolar disorder followed for a mean of three years, with month-by-month systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Comparison of rates of suicidal events during mood stabilizer monotherapy, antipsychotic monotherapy, and combination of mood stabilizer and antipsychotic.
Non-lethal suicide event rates were 9.4 times greater (chi2=28.29, p<.0001) during antipsychotic monotherapy and 3.5 times greater during mood stabilizer+antipsychotic (chi2=15.13, p=0.0001) than during mood stabilizer monotherapy.
Antipsychotics may have been prescribed because patients were at greater risk of suicidal behavior. First and second generation antipsychotics were not distinguished.
Treatment of bipolar patients with antipsychotics is associated with an increase in non-lethal suicidal behavior. Thus, use of antipsychotics for bipolar patients requires careful monitoring for suicidal behavior. Further studies are urgently needed to better characterize this relationship.

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    • "Yerevenian et al. found additional prescribing of antidepressants (Yerevanian et al., 2007b) or antipsychotics (Yerevanian et al., 2007a) in addition to mood stabilisers was associated with increases in suicide. Furthermore, those taking antipsychotic monotherapy or antidepressant monotherapy were at highest risk of suicide. "
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    ABSTRACT: The potential role of psychopharmacology in suicide prevention is often minimised. This may to some extent reflect that few medication trials have specifically focussed on prevention of suicidal behaviour--indeed this outcome is often not reported in trials. However, there is reasonably strong evidence that lithium may reduce risk of suicide, the postulated mechanism being a specific effect on aggression. Evidence is lacking with regard to any protective effect of other mood stabilizers. Clozapine may reduce suicidal behaviour in patients with schizophrenia, with reduction of affective symptoms being a possible explanation. The role of antidepressants in relation to suicide risk is highly controversial, especially in children and adolescents. It is unclear whether minor tranquillizers or hypnotics can assist in suicide prevention, although they can reduce the anxiety symptoms that may occur during initial treatment with SSRI antidepressants. It is also uncertain whether psychopharmacology has a role in preventing suicidal behaviour in people with personality disorders. Despite the limitations of the evidence we contend that suicide risk should be an important factor in deciding when and what to prescribe.
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    ABSTRACT: ABSTRACT A suicide attempt is a strong predictor of future suicide. The management,of patients who self-harm presents a challenge for psychiatric services. It is therefore important to identify factors that may be related to increased risk of suicidal behaviour in suicide attempters. The current study aimed to examine the prevalence of specific sleep dis- turbances in suicide attempters and possible associations between,sleep disturbances (including nightmares) and suicidal behaviour. A second focus was to test associations between sense of coherence and suicidality. Further, we tested whether Suicide As-
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  • No preview · Article · Dec 2007 · Journal of Affective Disorders
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