Psychiatry and Clinical Psychopharmacology

Schizophrenia and other psychotic disorders Suicide attempt with clozapine in a schizophrenia patient

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S216-S216
Read: 672 Published: 18 March 2021

Suicide is one of the causes of early death in schizophrenia patients. It has been shown that the patients with the diagnosis of schizophrenia are eight times more likely to commit suicide compared to general population. Also, depressive attacks, one of the major factors in suicide attempts, are more prevalent in schizophrenic patients. It is found that clozapine is more effective in reducing the rate of suicide attempts compared to antipsychotic treatments. Contrary to the related literature, this study is about the suicide attempt of a schizophrenic patient having depressive symptoms by taking clozapine orally. The patient is a 29 year-old, single male. He was admitted to the emergency service with the complaints of urinary incontinence, mental confusion, and epileptic attack. It was reported that he had taken 30 clozapine 100 mg tablet the previous day. He had metabolic acidosis; GCS point of three. Hemodialysis was performed. When the patient was taken over to psychiatry service, it was learnt that he had such complaints as introversion, suspicion, lack of interest, expressing that his internal organs operating improperly; and he has been treated with clozapine 300mg a day for seven years and had depressive complaints for 3 months. In psychiatric examination: oriented-cooperated, dysphoric and limited mood, restricted speech and poor content, no hallucination and delusion, sufficient attention-memory. He was calm and introvert with restricted social communication. By gradually increasing, he was treated by 300mg/a day quetiapine, 100mg/a day Sertraline and 15mg/a day Aripiprazole. He was discharged with partial remission. It is reported that the completed suicide rate in schizophrenia is nearly between 5-10%. As the risk factors of suicide in schizophrenia, the followings can be listed; unemployment, being single, living alone, maintaining insight, negative symptoms, prior suicide attempts, adverse effects, depressive mood and the feeling of hopelessness. It is known that comorbidity of major depression and schizophrenia is common, however it has been reported that more than half of the patients diagnosed as schizophrenia would go through depression episode at least once throughout their life. In our case, the patient was male, single, maintenance of insight and his hopeless-depressive mood, the negative symptoms were the existing risk factors for suicide attempts. In the case of schizophrenia patients with high risk of suicide and depressive mood, clozapine stands out for treatment. It is reported that clozapine can be used for the treatment of depression in schizophrenia and the finding about the anti-suicidal effects of clozapine are regarded as the effectiveness of this drug. However, it was observed that the treatment of clozapine did not prevent the patient from the idea of suicide and that the epileptic attacks occurring after the suicide attempt with clozapine and metabolic acidosis in blood threatened the patients’ lives. It is essential to evaluate the risk of suicide in schizophrenia patients. It is necessary to watch the thoughts stemming from schizophrenia, adverse effects of anti-psychotic drugs and depressive mood closely. In this respect, about anti-suicidal treatment, further information and research are required in addition to clozapine.
 

EISSN 2475-0581