Managementul psihofarmacologic al riscului de suicid la pacienţii cu schizofrenie

Abstract

Background: Managing the risk of suicide of patients with schizophrenia presents numerous challenges for clinicians. Compared with the general population, these patients have a risk of 8.5 percent more then others to commit a suicide. The literature that discusses the risk management of suicidal patients with schizophrenia is unanimous in the view that the problem statement requires only an integrated approach through psychosocial and pharmacological measures. The priority belongs to the antipsychotic drugs that can protect against suicidal risk. The second important target of medicine is removing the depressive symptoms in patients with schizophrenia. It is necessary to find out new methods, more effective treatments for suicidal behaviour and ideas of patients with schizophrenia. Conclusions: The treatment of patients with schizophrenia, that are at risk of suicide, involves a careful assessment of the risk factors and the development of a broad security plan that includes pharmaceutical and psycho-social interventions, which, if persevered for a long time, can minimize the risk of suicide. Carefully and judiciously selected antipsychotic medication may protect against suicidal risk, in this case, first-generation antipsychotics can be effective if regularly administered in adequate doses and invariably combined with antidepressants. Material accumulated evidence argues in favor of the second generation antipsychotics such as clozapine, which, according to some approved estimations, managed to decrease the suicide rate by 88%. Treatment of depressive symptoms in patients with schizophrenia is a task of first value, being well-known that the presence and especially the severity of the depressive status in these patients present a major risk for suicide. Selective receptor inhibitors (SSRI) and serotonin receptors are operators in relieving symptoms in patients with depressive schizophrenia as they can decrease the suicidal ideas.