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Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT).

Publication ,  Journal Article
Meltzer, HY; Alphs, L; Green, AI; Altamura, AC; Anand, R; Bertoldi, A; Bourgeois, M; Chouinard, G; Islam, MZ; Kane, J; Krishnan, R; Potkin, S ...
Published in: Arch Gen Psychiatry
January 2003

BACKGROUND: Approximately 50% of patients with schizophrenia or schizoaffective disorder attempt suicide, and approximately 10% die of suicide. Study results suggest that clozapine therapy significantly reduces suicidal behavior in these patients. METHODS: A multicenter, randomized, international, 2-year study comparing the risk for suicidal behavior in patients treated with clozapine vs olanzapine was conducted in 980 patients with schizophrenia or schizoaffective disorder, 26.8% of whom were refractory to previous treatment, who were considered at high risk for suicide because of previous suicide attempts or current suicidal ideation. To equalize clinical contact across treatments, all patients were seen weekly for 6 months and then biweekly for 18 months. Subsequent to randomization, unmasked clinicians at each site could make any interventions necessary to prevent the occurrence of suicide attempts. Suicidal behavior was assessed at each visit. Primary end points included suicide attempts (including those that led to death), hospitalizations to prevent suicide, and a rating of "much worsening of suicidality" from baseline. Masked raters, including an independent suicide monitoring board, determined when end point criteria were achieved. RESULTS: Suicidal behavior was significantly less in patients treated with clozapine vs olanzapine (hazard ratio, 0.76; 95% confidence interval, 0.58-0.97; P =.03). Fewer clozapine-treated patients attempted suicide (34 vs 55; P =.03), required hospitalizations (82 vs 107; P =.05) or rescue interventions (118 vs 155; P =.01) to prevent suicide, or required concomitant treatment with antidepressants (221 vs 258; P =.01) or anxiolytics or soporifics (301 vs 331; P =.03). Overall, few of these high-risk patients died of suicide during the study (5 clozapine vs 3 olanzapine-treated patients; P =.73). CONCLUSIONS: Clozapine therapy demonstrated superiority to olanzapine therapy in preventing suicide attempts in patients with schizophrenia and schizoaffective disorder at high risk for suicide. Use of clozapine in this population should lead to a significant reduction in suicidal behavior.

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Published In

Arch Gen Psychiatry

DOI

ISSN

0003-990X

Publication Date

January 2003

Volume

60

Issue

1

Start / End Page

82 / 91

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Suicide, Attempted
  • Suicide Prevention
  • Suicide
  • Severity of Illness Index
  • Schizophrenic Psychology
  • Schizophrenia
  • Risk Factors
  • Psychotic Disorders
  • Psychiatry
 

Citation

APA
Chicago
ICMJE
MLA
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Meltzer, H. Y., Alphs, L., Green, A. I., Altamura, A. C., Anand, R., Bertoldi, A., … International Suicide Prevention Trial Study Group, . (2003). Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry, 60(1), 82–91. https://doi.org/10.1001/archpsyc.60.1.82
Meltzer, Herbert Y., Larry Alphs, Alan I. Green, A Carlo Altamura, Ravi Anand, Alberto Bertoldi, Marc Bourgeois, et al. “Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT).Arch Gen Psychiatry 60, no. 1 (January 2003): 82–91. https://doi.org/10.1001/archpsyc.60.1.82.
Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003 Jan;60(1):82–91.
Meltzer, Herbert Y., et al. “Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT).Arch Gen Psychiatry, vol. 60, no. 1, Jan. 2003, pp. 82–91. Pubmed, doi:10.1001/archpsyc.60.1.82.
Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, Bourgeois M, Chouinard G, Islam MZ, Kane J, Krishnan R, Lindenmayer JP, Potkin S, International Suicide Prevention Trial Study Group. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003 Jan;60(1):82–91.

Published In

Arch Gen Psychiatry

DOI

ISSN

0003-990X

Publication Date

January 2003

Volume

60

Issue

1

Start / End Page

82 / 91

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Suicide, Attempted
  • Suicide Prevention
  • Suicide
  • Severity of Illness Index
  • Schizophrenic Psychology
  • Schizophrenia
  • Risk Factors
  • Psychotic Disorders
  • Psychiatry