Does Treatment for SA Disorders Reduce Suicidality ?

1. Does Treatment for SA Disorders Reduce Suicidality? • Does lithium reduce suicidality in …..polar mood disorders? • The mechanism of action is not well defined and may be associated with either a prevention of mood recurrences or a more specific "antisuicidal" activity. EpidemiolPsichiatr Soc. 2009 Jul-Sep;18(3):179-83.. • If this is the case, increasing lithium levels of drinking water could potentially reduce the risk of suicide, and justify administering lithium to tap water. Med Hypotheses. 2009 Nov;73(5):811-2. Epub 2009 May 19. • Does clozapine reduce suicidality in schizo…….. Disorders? • The strongest and perhaps unique evidence has been shown for clozapine, which seems to have a clinically relevant advantage over both first- and second-generation antipsychotics for reducing suicidality. Although clozapine has not yet demonstrated a specific preventing effect on completed suicide in patients with schizophrenia, it should be considered when suicide risk is detected in a patient with schizophrenia. Psychopharmacol Bull. 2007;40(3):128-42.

2. How are studies conducted? • In studies conducted over the past 20 years, aimed at seeking FDA approval for treatment of alcohol, cocaine, methamphetamine, and opiate dependence: • Inclusion criteria – current substance dependence, seeking treatment. • Exclusion criteria • No SI/SA in the past 30 days, 60 days, 365 days • NO or No UNSTABLE Axis I disorders • Research clinic “visits” 1-3 times per week +/- SA counseling – may be 3-6 hours per week of contact • Really can be daily contact with study staff. • Screening and outcomes include ASI – has suicide questions • D18 – How many times have you OD’d on drugs (prompts to ask about SA’s) • Have you had a significant period of time in which you: • P9 – Experienced serious thoughts of suicide • P10 – Attempted suicide • At the time of the interview, is the client: • P20 - Having suicidal thoughts • Result: • Immediate loss of external validity

3. Disulfiram • ActaPsychiatr Scand. 1999 Mar;99(3):214-9. • Treatment received by alcohol-dependent suicide attempters. • During the final month before the attempt, half of the subjects (51%) had been treated by health care services; 11% had received disulfiram-treatment and 6% had received psychotherapy. After 1 month, 64% were being treated by health care services. However, only 14% were receiving disulfiram-treatment and 9% were receiving psychotherapy. These findings suggest that the quality and activity of treatment offered to suicide attempters with alcohol dependence should be improved.

4. Sher L. Alcoholism and suicidal behavior: a clinical overview.Acta Psychiatr Scand 2006: 113: 13–22. • The clinician should notice that suicidal behavior is common in individuals with alcoholism and that suicidal behavior is especially frequent in patients with comorbid alcoholism and major depression • All patients with alcoholism must be evaluated for suicide risk • Individuals with alcoholism should receive appropriate treatment of comorbid psychiatric and medical disorders • Psychosocial support, especially at the time of crisis, is very important.

5. Palmer, et al. Alcohol and Alcoholism (2000) 35 (5): 478-492. • The suicide rate among alcohol-misusing patients is 58–70-fold higher than among non-alcohol misusing patients (Kessel and Grossman, 1961; Kendell and Staton, 1966; Gillis, 1969; Leschet al., 1986) and one-fifth to one-third of the increased death rate among alcoholics is explained by suicide. The suicide rate is related to the level of alcohol consumption (Berglund and Ojehagen, 1998). Successful treatment of alcoholics leads to decreased suicide rates compared to unsuccessfully or untreated patients (Kendell and Staton, 1966; Gillis, 1969).

6. So….. • Randomized, double-blind clinical trial provide NO information about the effects of treatment or treatment medications on SI/SA among treatment seeking substance abuse populations.