Patchan Kathleen M, Richardson Charles, Vyas Gopal, Kelly Deanna L
University of Maryland/Sheppard Pratt Psychiatry, Department of Psychiatry, Psychiatry Residency Program, Baltimore, MD USA.
Ann Clin Psychiatry. 2015 Nov;27(4):253-6.
Clozapine is a second-generation antipsychotic that has been shown to reduce suicidal ideation and suicidal behaviors in patients with schizophrenia. However, it is underutilized because of its serious side effects.
We describe 3 patients with a history of suicide ideation and attempts who were successfully treated and maintained in the community without suicidal tendencies while taking clozapine. All 3 patients, men in their 20s, discontinued clozapine because of side effects and subsequently committed suicide. We also review the literature on clozapine's effects on suicidality.
In these 3 cases, suicide followed abrupt discontinuation of clozapine or transition to another antipsychotic.
This case series is the first of its kind to document the risk of suicide when clozapine is discontinued. The decision to discontinue clozapine should be made carefully, especially because clozapine is considered the treatment of last resort for patients with treatment-resistant schizophrenia and suicidal ideation. We stress the importance of minimizing the risk of abrupt clozapine discontinuation and recommend further evaluation of suicide ideation and attempts when clozapine is discontinued.
氯氮平是一种第二代抗精神病药物，已被证明可降低精神分裂症患者的自杀意念和自杀行为。然而，由于其严重的副作用，其使用未得到充分利用。
我们描述了3例有自杀意念和自杀未遂史的患者，他们在服用氯氮平期间在社区中成功接受治疗并维持，且无自杀倾向。所有3例患者均为20多岁的男性，因副作用停用氯氮平，随后自杀。我们还回顾了关于氯氮平对自杀倾向影响的文献。
在这3例病例中，自杀发生在氯氮平突然停药或换用另一种抗精神病药物之后。
这个病例系列是首个记录氯氮平停药时自杀风险的系列。停用氯氮平的决定应谨慎做出，特别是因为氯氮平被认为是难治性精神分裂症和有自杀意念患者的最后一线治疗药物。我们强调将氯氮平突然停药的风险降至最低的重要性，并建议在停用氯氮平时进一步评估自杀意念和自杀未遂情况。
