Pharmacologic Approaches to Suicide Prevention in Outpatient Settings-View Presentation

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This session featured three linked talks on suicide prevention, postvention, and schizophrenia care.<br /><br />Dr. David Sheehan argued that suicidality is not one single phenomenon but likely a set of distinct phenotypes that respond differently to treatment. He described categories such as psychotic, depressive, substance-induced, medical/neurological, and “impulse attack suicidality disorder,” a newly proposed syndrome marked by sudden, urgent, unpredictable impulses to kill oneself. He criticized current suicide assessment systems for missing large amounts of clinically important change and said linear “staircase” models of suicide progression do not match real-world patterns. He emphasized that suicidality can be independent of depression, may have genetic vulnerability, and should be measured with better structured interviews and dimensional tracking scales. He also reviewed evidence suggesting lithium and ketamine may reduce suicidality in some settings.<br /><br />Dr. Sidney Zisek focused on suicide bereavement and prolonged grief disorder. He explained that survivors after suicide are themselves a high-risk group for depression, PTSD, suicidal ideation, and suicide. He described prolonged grief disorder as grief that becomes stuck and chronic rather than integrating over time. In randomized trials, specialized prolonged grief therapy was highly effective, while citalopram alone was not clearly beneficial for grief. Therapy also reduced suicidal ideation, including in people bereaved by suicide. Medication adherence was poorer when used alone in suicide-bereaved patients, but improved when combined with therapy.<br /><br />Dr. Ira Glick concluded with practical guidance for schizophrenia: provide long-term, individualized, team-based treatment; involve family; use good psychosocial care; monitor side effects; and use clozapine liberally, since it is the key antipsychotic with evidence for reducing suicide risk.

Keywords

suicide prevention

suicidality phenotypes

impulse attack suicidality disorder

suicide assessment

prolonged grief disorder

suicide bereavement

prolonged grief therapy

suicidal ideation

schizophrenia care

clozapine

lithium

ketamine