patients with refractory schizophrenia and schizoaffective disorder who stayed persistent suicidal

Q: 24 years old male with an established diagnosis of schizophrenia and previous suicidal ideations is admitted again with similar symptoms. Trial of which medicine is indicated? (select one) 

A) Clozapine 

B) Olanzapine

Answer: A

Clozapine stands out to work amongst all antipsychotics for patients with refractory schizophrenia and schizoaffective disorder who stayed persistent with suicidal tendencies. This is based on a strong study of about 90,000 patients from Europe. 

Clozapine is approved for this indication by US Food and Drug Administration (FDA). 

Due to its potential side effects, it is reserved as a second-line of treatment.

#psychiatry

References:

1. Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60:82. 

2. Taipale H, Lähteenvuo M, Tanskanen A, et al. Comparative Effectiveness of Antipsychotics for Risk of Attempted or Completed Suicide Among Persons With Schizophrenia. Schizophr Bull 2021; 47:23.