New Hot Paper Comment by Herbert Meltzer

Herbert Meltzer answers a few questions about this month's new hot paper in the field of Psychiatry/Psychology.

From •>>March 2004

Field: Psychiatry/Psychology
Article Title: Clozapine treatment for suicidality in schizophrenia - International Suicide Prevention Trial (InterSePT)
Authors: Meltzer, HY;Alphs, L;Green, AI;Altamura, AC;Anand, R;Bertoldi, A;Bourgeois, M;Chouinard, G;Islam, Z;Kane, J;Krishnan, R;Lindenmayer, JP;Potkin, S
Journal: ARCH GEN PSYCHIAT
Volume: 60
Page: 82-91
Year: JAN 2003
* Psychiat Hosp Vanderbilt, 1601 23rd Ave S, Suite 306, Nashville, TN 37212 USA.
* Vanderbilt Univ, Dept Psychiat, Nashville, TN 37240 USA.
* Pfizer Inc, Ann Arbor, MI USA.
* Dartmouth Coll Sch Med, Dept Psychiat, Hanover, MA USA.
* Univ Milan, Dept Psychiat, I-20122 Milan, Italy.
* Organon, Dept Psychiat, Oss, Netherlands.
* Natl Univ La Plata, Dept Psychiat, RA-1900 La Plata, Argentina.
* Univ Bordeaux, Dept Psychiat, Bordeaux, France.
* McGill Univ, Dept Psychiat, Montreal, PQ H3A 2T5, Canada.
* Univ Montreal, Dept Psychiat, Montreal, PQ H3C 3J7, Canada.
* Novartis Pharmaceut Corp, E Hanover, NJ USA.
* Hillside Hosp, Dept Psychiat, Glen Oaks, NY 11004 USA.
* Albert Einstein Univ, Dept Psychiat, Bronx, NY USA.
* Duke Univ, Dept Psychiat, Durham, NC 27706 USA.
* Nathan S Kline Inst Psychiat Res, Manhattan Psychiat Ctr, Dept Psychiat, Wards Island, NY USA.
* Univ Calif Irvine, Dept Psychiat, Irvine, CA 92697 USA.

Why do you think your paper is highly cited?

“This study provided the first A level clinical trial evidence that clozapine could reduce the risk for suicide.”

This paper was the first controlled study to show that a drug treatment could reduce the risk of suicide attempts in patients with schizophrenia or schizoaffective treatment. At least 25% of patients with this illness make a serious suicide attempt and at least 5% of them die by suicide. This study led to the FDA approving an indication for clozapine to reduce the risk of suicide in these two disorders.

Does it describe a new discovery or a new methodology that's useful to others?

This study, as mentioned above, provided the first A level clinical trial evidence that clozapine could reduce the risk for suicide. It confirmed previous cohort and mirror image retrospective studies. It also did provide new methodology for how to do such studies in psychiatric diagnoses such as bipolar disorder and depression.

Could you summarize the significance of your paper in layman's terms?

Application of the treatment information in this study could lead to saving lives and suffering by reducing suicide attempts by at least 10-20% when compared with other treatments for schizophrenia.

How did you become involved in this research?

In 1994, I published the first evidence that clozapine appeared to reduce the risk for suicide attempts in patients with schizophrenia. This was a mirror image study and was confounded by increased psychosocial treatment and clinical contact with the patients in the study. Other follow up studies confirmed the results but were also subject to criticism. This study design was approved by the FDA and avoided the major confounds through innovative design. This study was sponsored by Novartis despite the fact that the possibility of financial gain was minimal at best. As it turned out, the study worked but Novartis did not reap any financial return. A key issue which remains to be resolved is if this evidence-backed medicine will, in fact, influence clinical practice to any extent. My future research, if funded by NIMH, will address this issue.

Herbert Y. Meltzer, M.D.
Psychiatric Hospital at Vanderbilt
Nashville, TN, USA

ESI Special Topics, March 2004
Citing URL - http://www.esi-topics.com/nhp/2004/march-04-HerbertMeltzer.html