title: Suicidality in clozapine-treated patients with schizophrenia: role of obsessive-compulsive symptoms.
abstract: Patients with schizophrenia have an increased lifetime risk of comorbid obsessive-compulsive symptoms. Up to 30% of these patients experience such symptoms and 12% may be diagnosed with obsessive-compulsive disorder. The presence of these symptoms in schizophrenia seems to be associated with poor outcomes including a greater suicidal risk. A subgroup of patients develops this symptomatology after the initiation with Second Generation Antipsychotics (SGA). Also, there is evidence of a causal relationship for this association, particularly for clozapine. The primary aim of this study was to investigate the association of this comorbidity with suicidality in a population of clozapine-medicated schizophrenic and schizoaffective patients (N=65). The prevalence of obsessive-compulsive symptoms in our sample was 29.2% (N=19) and the prevalence of obsessive-compulsive disorder was 13.8% (N=9). Significant positive correlations between suicidality and total Y-BOCS score and between Y- BOCS score and depressive symptoms were found. Further analysis indicated that a Y-BOCS score greater or equal than 8 was an independent predictor of suicide attempt during clozapine treatment. Routine screening for this adverse event should be warranted for this population.
authors.affiliation: Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Av Warnes 2630, Capital Federal, Argentina. Electronic address: alejandroszm@gmail.com.
authors.forename: Alejandro G
authors.initials: AG
authors.lastname: Szmulewicz
authors.affiliation: Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Av Warnes 2630, Capital Federal, Argentina.
authors.forename: José M
authors.initials: JM
authors.lastname: Smith
authors.affiliation: Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Av Warnes 2630, Capital Federal, Argentina.
authors.forename: Marina P
authors.initials: MP
authors.lastname: Valerio
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult; D000092864:Suicide Prevention
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Clozapine; Obsessive-compulsive disorder; Schizo-OCD-Suicide; Schizophrenia; Suicide attempt