Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial

Steven G. Potkin, Larry Alphs, Chuanchieh Hsu, K. Ranga Rama Krishnan, Ravi Anand, Frederick K. Young, Herbert Meltzer, Alan Green, Saide Altinsan, Siemion Altman, Likiana Avigo, Richard Balon, Vanda Benešová, Luis Bengochea, Istvan Bitter, Elisabeth Bokowska, Bernardo Carpiniello, Daniel Casey, Giovanni Cassano, James ChouGuy Chouinard, Libor Chvila, Jean Dalery, Pedro Delgado, Liliana Dell'Osso, Carl Eisdorfer, Robin A. Emsley, T. A. Fahy, Vera Folnegovic, Sophie Frangou, Pedro Gargoloff, Alberto Giannelli, Ira Glick, Richard Greenberg, George T. Grossberg, Doris Gundersen, Hannale Heila, George Hsu, Naveed Iqbal, M. Miro Jakovljevic, Richard C. Josiassen, Akos Kassaifarkas, Rob Kerwin, Frederic Khidichian, Mary Ann Knesevich, Jack Krasuski, Vinod Kumar, Veronica Walters Larach, Michael Lesem, Shon Lewis, Pierre Michel Llorca, H. Edward Logue, Stephen Martin, Muriel Maurel-Raymondet, Laszlo Mod, Eva Morik, Carlos Morra, Ann Mortimer, Mojtaba Noursalehi, Gyorgy Ostorharics-Horvath, Ivo Paclt, Jorg J. Pahl, Jeffrey Lee Peters, Rosario Pioli, Michael G. Plopper, Thomas Posever, Mark Rapaport, Delbert Robinson, Carlo Andrea Robotti, Frederic Rouillon, David Sack, Isaac Sakinsofsky, Phillip Seibel, George Simpson, Nancy Temkin, Oladapo Tomori, Santha Vaidain, Zdeòka Vyhnándová, Daniel Zimbroff, Marie Agathe Zimmerman

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Background: Enhanced ability to reliably identify risk factors for suicidal behavior permits more focused decisions concerning treatment interventions and support services, with potential reduction in lives lost to suicide. Methods: This study followed 980 patients at high risk for suicide in a multicenter prospective study for 2 years after randomization to clozapine or olanzapine. A priori predictors related to diagnosis, treatment resistance, and clinical constructs of disease symptoms were evaluated as possible predictors of subsequent suicide-related events. Results: Ten baseline univariate predictors were identified. Historical predictors were diagnosis of schizoaffective disorder, history or current use at baseline of alcohol or substance abuse, cigarette smoking, number of lifetime suicide attempts, and the number of hospitalizations in the previous 36 months to prevent suicide. Predictive clinical features included greater baseline scores on the InterSePT scale for suicidal thinking, the Covi Anxiety Scale, the Calgary Depression Scale (CDS), and severity of Parkinsonism. Subsequent multivariate analysis revealed the number of hospitalizations in the previous 36 months, baseline CDS, severity of Parkinson's, history of substance abuse, and lifetime suicide attempts. Clozapine, in general, was more effective than olanzapine in decreasing the risk of suicidality, regardless of risk factors present. Conclusions: This is the first prospective analysis of predictors of suicide risk in a large schizophrenic and schizoaffective population judged to be at high risk for suicide. Assessment of these risk factors may aid clinicians in evaluating risk for suicidal behaviors so that appropriate interventions can be made.

Original languageEnglish (US)
Pages (from-to)444-452
Number of pages9
JournalBiological Psychiatry
Volume54
Issue number4
DOIs
StatePublished - Aug 15 2003
Externally publishedYes

Fingerprint

Suicide
olanzapine
Clozapine
Substance-Related Disorders
Hospitalization
Depression
Aptitude
Parkinsonian Disorders
Random Allocation
Risk-Taking
Psychotic Disorders
Alcoholism
Multicenter Studies
Multivariate Analysis
Anxiety
Smoking
History
Prospective Studies
Therapeutics
Population

Keywords

  • Clozapine
  • Olanzapine
  • Risk factors
  • Schizoaffective disorder
  • Schizophrenia
  • Suicidality
  • Suicide

ASJC Scopus subject areas

  • Biological Psychiatry

Cite this

Potkin, S. G., Alphs, L., Hsu, C., Krishnan, K. R. R., Anand, R., Young, F. K., ... Zimmerman, M. A. (2003). Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial. Biological Psychiatry, 54(4), 444-452. https://doi.org/10.1016/S0006-3223(03)00178-1

Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial. / Potkin, Steven G.; Alphs, Larry; Hsu, Chuanchieh; Krishnan, K. Ranga Rama; Anand, Ravi; Young, Frederick K.; Meltzer, Herbert; Green, Alan; Altinsan, Saide; Altman, Siemion; Avigo, Likiana; Balon, Richard; Benešová, Vanda; Bengochea, Luis; Bitter, Istvan; Bokowska, Elisabeth; Carpiniello, Bernardo; Casey, Daniel; Cassano, Giovanni; Chou, James; Chouinard, Guy; Chvila, Libor; Dalery, Jean; Delgado, Pedro; Dell'Osso, Liliana; Eisdorfer, Carl; Emsley, Robin A.; Fahy, T. A.; Folnegovic, Vera; Frangou, Sophie; Gargoloff, Pedro; Giannelli, Alberto; Glick, Ira; Greenberg, Richard; Grossberg, George T.; Gundersen, Doris; Heila, Hannale; Hsu, George; Iqbal, Naveed; Jakovljevic, M. Miro; Josiassen, Richard C.; Kassaifarkas, Akos; Kerwin, Rob; Khidichian, Frederic; Knesevich, Mary Ann; Krasuski, Jack; Kumar, Vinod; Larach, Veronica Walters; Lesem, Michael; Lewis, Shon; Llorca, Pierre Michel; Logue, H. Edward; Martin, Stephen; Maurel-Raymondet, Muriel; Mod, Laszlo; Morik, Eva; Morra, Carlos; Mortimer, Ann; Noursalehi, Mojtaba; Ostorharics-Horvath, Gyorgy; Paclt, Ivo; Pahl, Jorg J.; Peters, Jeffrey Lee; Pioli, Rosario; Plopper, Michael G.; Posever, Thomas; Rapaport, Mark; Robinson, Delbert; Robotti, Carlo Andrea; Rouillon, Frederic; Sack, David; Sakinsofsky, Isaac; Seibel, Phillip; Simpson, George; Temkin, Nancy; Tomori, Oladapo; Vaidain, Santha; Vyhnándová, Zdeòka; Zimbroff, Daniel; Zimmerman, Marie Agathe.

In: Biological Psychiatry, Vol. 54, No. 4, 15.08.2003, p. 444-452.

Research output: Contribution to journalArticle

Potkin, SG, Alphs, L, Hsu, C, Krishnan, KRR, Anand, R, Young, FK, Meltzer, H, Green, A, Altinsan, S, Altman, S, Avigo, L, Balon, R, Benešová, V, Bengochea, L, Bitter, I, Bokowska, E, Carpiniello, B, Casey, D, Cassano, G, Chou, J, Chouinard, G, Chvila, L, Dalery, J, Delgado, P, Dell'Osso, L, Eisdorfer, C, Emsley, RA, Fahy, TA, Folnegovic, V, Frangou, S, Gargoloff, P, Giannelli, A, Glick, I, Greenberg, R, Grossberg, GT, Gundersen, D, Heila, H, Hsu, G, Iqbal, N, Jakovljevic, MM, Josiassen, RC, Kassaifarkas, A, Kerwin, R, Khidichian, F, Knesevich, MA, Krasuski, J, Kumar, V, Larach, VW, Lesem, M, Lewis, S, Llorca, PM, Logue, HE, Martin, S, Maurel-Raymondet, M, Mod, L, Morik, E, Morra, C, Mortimer, A, Noursalehi, M, Ostorharics-Horvath, G, Paclt, I, Pahl, JJ, Peters, JL, Pioli, R, Plopper, MG, Posever, T, Rapaport, M, Robinson, D, Robotti, CA, Rouillon, F, Sack, D, Sakinsofsky, I, Seibel, P, Simpson, G, Temkin, N, Tomori, O, Vaidain, S, Vyhnándová, Z, Zimbroff, D & Zimmerman, MA 2003, 'Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial', Biological Psychiatry, vol. 54, no. 4, pp. 444-452. https://doi.org/10.1016/S0006-3223(03)00178-1
Potkin, Steven G. ; Alphs, Larry ; Hsu, Chuanchieh ; Krishnan, K. Ranga Rama ; Anand, Ravi ; Young, Frederick K. ; Meltzer, Herbert ; Green, Alan ; Altinsan, Saide ; Altman, Siemion ; Avigo, Likiana ; Balon, Richard ; Benešová, Vanda ; Bengochea, Luis ; Bitter, Istvan ; Bokowska, Elisabeth ; Carpiniello, Bernardo ; Casey, Daniel ; Cassano, Giovanni ; Chou, James ; Chouinard, Guy ; Chvila, Libor ; Dalery, Jean ; Delgado, Pedro ; Dell'Osso, Liliana ; Eisdorfer, Carl ; Emsley, Robin A. ; Fahy, T. A. ; Folnegovic, Vera ; Frangou, Sophie ; Gargoloff, Pedro ; Giannelli, Alberto ; Glick, Ira ; Greenberg, Richard ; Grossberg, George T. ; Gundersen, Doris ; Heila, Hannale ; Hsu, George ; Iqbal, Naveed ; Jakovljevic, M. Miro ; Josiassen, Richard C. ; Kassaifarkas, Akos ; Kerwin, Rob ; Khidichian, Frederic ; Knesevich, Mary Ann ; Krasuski, Jack ; Kumar, Vinod ; Larach, Veronica Walters ; Lesem, Michael ; Lewis, Shon ; Llorca, Pierre Michel ; Logue, H. Edward ; Martin, Stephen ; Maurel-Raymondet, Muriel ; Mod, Laszlo ; Morik, Eva ; Morra, Carlos ; Mortimer, Ann ; Noursalehi, Mojtaba ; Ostorharics-Horvath, Gyorgy ; Paclt, Ivo ; Pahl, Jorg J. ; Peters, Jeffrey Lee ; Pioli, Rosario ; Plopper, Michael G. ; Posever, Thomas ; Rapaport, Mark ; Robinson, Delbert ; Robotti, Carlo Andrea ; Rouillon, Frederic ; Sack, David ; Sakinsofsky, Isaac ; Seibel, Phillip ; Simpson, George ; Temkin, Nancy ; Tomori, Oladapo ; Vaidain, Santha ; Vyhnándová, Zdeòka ; Zimbroff, Daniel ; Zimmerman, Marie Agathe. / Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial. In: Biological Psychiatry. 2003 ; Vol. 54, No. 4. pp. 444-452.
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T1 - Predicting suicidal risk in schizophrenic and schizoaffective patients in a prospective two-year trial

AU - Potkin, Steven G.

AU - Alphs, Larry

AU - Hsu, Chuanchieh

AU - Krishnan, K. Ranga Rama

AU - Anand, Ravi

AU - Young, Frederick K.

AU - Meltzer, Herbert

AU - Green, Alan

AU - Altinsan, Saide

AU - Altman, Siemion

AU - Avigo, Likiana

AU - Balon, Richard

AU - Benešová, Vanda

AU - Bengochea, Luis

AU - Bitter, Istvan

AU - Bokowska, Elisabeth

AU - Carpiniello, Bernardo

AU - Casey, Daniel

AU - Cassano, Giovanni

AU - Chou, James

AU - Chouinard, Guy

AU - Chvila, Libor

AU - Dalery, Jean

AU - Delgado, Pedro

AU - Dell'Osso, Liliana

AU - Eisdorfer, Carl

AU - Emsley, Robin A.

AU - Fahy, T. A.

AU - Folnegovic, Vera

AU - Frangou, Sophie

AU - Gargoloff, Pedro

AU - Giannelli, Alberto

AU - Glick, Ira

AU - Greenberg, Richard

AU - Grossberg, George T.

AU - Gundersen, Doris

AU - Heila, Hannale

AU - Hsu, George

AU - Iqbal, Naveed

AU - Jakovljevic, M. Miro

AU - Josiassen, Richard C.

AU - Kassaifarkas, Akos

AU - Kerwin, Rob

AU - Khidichian, Frederic

AU - Knesevich, Mary Ann

AU - Krasuski, Jack

AU - Kumar, Vinod

AU - Larach, Veronica Walters

AU - Lesem, Michael

AU - Lewis, Shon

AU - Llorca, Pierre Michel

AU - Logue, H. Edward

AU - Martin, Stephen

AU - Maurel-Raymondet, Muriel

AU - Mod, Laszlo

AU - Morik, Eva

AU - Morra, Carlos

AU - Mortimer, Ann

AU - Noursalehi, Mojtaba

AU - Ostorharics-Horvath, Gyorgy

AU - Paclt, Ivo

AU - Pahl, Jorg J.

AU - Peters, Jeffrey Lee

AU - Pioli, Rosario

AU - Plopper, Michael G.

AU - Posever, Thomas

AU - Rapaport, Mark

AU - Robinson, Delbert

AU - Robotti, Carlo Andrea

AU - Rouillon, Frederic

AU - Sack, David

AU - Sakinsofsky, Isaac

AU - Seibel, Phillip

AU - Simpson, George

AU - Temkin, Nancy

AU - Tomori, Oladapo

AU - Vaidain, Santha

AU - Vyhnándová, Zdeòka

AU - Zimbroff, Daniel

AU - Zimmerman, Marie Agathe

PY - 2003/8/15

Y1 - 2003/8/15

N2 - Background: Enhanced ability to reliably identify risk factors for suicidal behavior permits more focused decisions concerning treatment interventions and support services, with potential reduction in lives lost to suicide. Methods: This study followed 980 patients at high risk for suicide in a multicenter prospective study for 2 years after randomization to clozapine or olanzapine. A priori predictors related to diagnosis, treatment resistance, and clinical constructs of disease symptoms were evaluated as possible predictors of subsequent suicide-related events. Results: Ten baseline univariate predictors were identified. Historical predictors were diagnosis of schizoaffective disorder, history or current use at baseline of alcohol or substance abuse, cigarette smoking, number of lifetime suicide attempts, and the number of hospitalizations in the previous 36 months to prevent suicide. Predictive clinical features included greater baseline scores on the InterSePT scale for suicidal thinking, the Covi Anxiety Scale, the Calgary Depression Scale (CDS), and severity of Parkinsonism. Subsequent multivariate analysis revealed the number of hospitalizations in the previous 36 months, baseline CDS, severity of Parkinson's, history of substance abuse, and lifetime suicide attempts. Clozapine, in general, was more effective than olanzapine in decreasing the risk of suicidality, regardless of risk factors present. Conclusions: This is the first prospective analysis of predictors of suicide risk in a large schizophrenic and schizoaffective population judged to be at high risk for suicide. Assessment of these risk factors may aid clinicians in evaluating risk for suicidal behaviors so that appropriate interventions can be made.

AB - Background: Enhanced ability to reliably identify risk factors for suicidal behavior permits more focused decisions concerning treatment interventions and support services, with potential reduction in lives lost to suicide. Methods: This study followed 980 patients at high risk for suicide in a multicenter prospective study for 2 years after randomization to clozapine or olanzapine. A priori predictors related to diagnosis, treatment resistance, and clinical constructs of disease symptoms were evaluated as possible predictors of subsequent suicide-related events. Results: Ten baseline univariate predictors were identified. Historical predictors were diagnosis of schizoaffective disorder, history or current use at baseline of alcohol or substance abuse, cigarette smoking, number of lifetime suicide attempts, and the number of hospitalizations in the previous 36 months to prevent suicide. Predictive clinical features included greater baseline scores on the InterSePT scale for suicidal thinking, the Covi Anxiety Scale, the Calgary Depression Scale (CDS), and severity of Parkinsonism. Subsequent multivariate analysis revealed the number of hospitalizations in the previous 36 months, baseline CDS, severity of Parkinson's, history of substance abuse, and lifetime suicide attempts. Clozapine, in general, was more effective than olanzapine in decreasing the risk of suicidality, regardless of risk factors present. Conclusions: This is the first prospective analysis of predictors of suicide risk in a large schizophrenic and schizoaffective population judged to be at high risk for suicide. Assessment of these risk factors may aid clinicians in evaluating risk for suicidal behaviors so that appropriate interventions can be made.

KW - Clozapine

KW - Olanzapine

KW - Risk factors

KW - Schizoaffective disorder

KW - Schizophrenia

KW - Suicidality

KW - Suicide

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