MIRECC and Behavioral Health Service, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania 15206, USA.
CNS Drugs. 2011 Feb;25(2):129-43. doi: 10.2165/11586450-000000000-00000.
The management of suicide risk in patients with schizophrenia poses many challenges for clinicians. Compared with the general population, these patients have an 8.5-fold greater risk of suicide. This article reviews the literature dealing with the treatment of at-risk patients with schizophrenia. An integrated psychosocial and pharmacological approach to managing this population of patients is recommended. Although there is at least modest evidence suggesting that antipsychotic medications protect against suicidal risk, the evidence appears to be most favourable for second-generation antipsychotics, particularly clozapine, which is the only medication approved by the US FDA for preventing suicide in patients with schizophrenia. In addition, treating depressive symptoms in patients with schizophrenia is an important component of suicide risk reduction. While selective serotonin receptor inhibitors (SSRIs) ameliorate depressive symptoms in patients with schizophrenia, they also appear to attenuate suicidal thoughts. Further research is needed to more effectively personalize the treatment of suicidal thoughts and behaviours and the prevention of suicide in patients with schizophrenia.
精神分裂症患者的自杀风险管理对临床医生来说是一个巨大的挑战。与一般人群相比，这些患者自杀的风险高 8.5 倍。本文回顾了有关治疗有自杀风险的精神分裂症患者的文献。建议对这一患者群体采用综合的心理社会和药物治疗方法。尽管有一些证据表明抗精神病药物可以预防自杀风险，但证据似乎最有利于第二代抗精神病药物，特别是氯氮平，它是唯一被美国 FDA 批准用于预防精神分裂症患者自杀的药物。此外，治疗精神分裂症患者的抑郁症状是降低自杀风险的一个重要组成部分。选择性 5-羟色胺再摄取抑制剂 (SSRIs) 可以改善精神分裂症患者的抑郁症状，但也似乎可以减轻自杀念头。需要进一步的研究来更有效地针对精神分裂症患者的自杀念头和行为进行个体化治疗，并预防自杀。
