Pharmacotherapy and Suicide Risk in Schizophrenia

The authors examined drug prescribing patterns and incidence of side effects in schizophrenic patients who committed suicide as compared with a matched control group. The groups did not differ in type of drug prescribed, though patients in the suicide group received significantly higher doses of fluphenazine enanthate. Extrapyramidal reactions occurred more frequently among the patients in the suicide group in the thirty days preceding suicide, and autonomic side effects less frequently, than in control patients for a corresponding period prior to discharge. The authors conclude that the probability of suicide is not related to the type of drug prescribed.

Fluphenazine Resistant Psychosis

A fifty year old female chronic schizophrenic was admitted to hospital following a relapse of her psychosis. She had previously responded well to treatment with trifluoperazine but because of her history of medication non-compliance, a trial of fluphenazine enanthate was instituted. Despite the close chemical similarity between trifluoperazine and fluphenazine the patient failed to respond to the latter in either its oral or depot intramuscular form. Although it is not unusual for a patient to respond to one antipsychotic and not to another, the above case of intra-class non-responsiveness is indeed rare and not readily explained. We present this unusual case and discuss some possible explanations.