Suicide risk and antipsychotic side effects in schizophrenia: nested case-control study

Hum Psychopharmacol. 2016 Jul;31(4):341-5. doi: 10.1002/hup.2536. Epub 2016 Apr 25.


Objective: This study explores suicide risk in schizophrenia in relation to side effects from antipsychotic medication.

Methods: Among patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4000), those who died by suicide within 5 years from diagnosis were defined as cases (n = 84; 54% male). For each case, one individually matched control was identified from the same population. Information on antipsychotic side effects, including extrapyramidal symptoms (EPS) and akathisia, as well as prescriptions of anticholinergic medication, was retrieved from clinical records in a blinded fashion. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of the association between suicide and side effects as well as anticholinergic medication were estimated using conditional logistic regression.

Results: A lower suicide risk was found in patients with a history of EPS (aOR 0.33, 95% CI 0.12-0.94). There was no statistically significant association between akathisia or anticholinergic medication use and the suicide risk.

Conclusions: A lower suicide risk identified among patients with EPS could potentially reflect higher antipsychotic adherence, exposure to higher dosage, or polypharmacy among these patients. Copyright © 2016 John Wiley & Sons, Ltd.

Keywords: akathisia; antipsychotics; schizophrenia; side effects; suicide.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antipsychotic Agents / adverse effects*
  • Basal Ganglia Diseases / chemically induced*
  • Basal Ganglia Diseases / diagnosis
  • Basal Ganglia Diseases / epidemiology
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy*
  • Schizophrenia / epidemiology
  • Schizophrenic Psychology*
  • Single-Blind Method
  • Suicide / psychology*
  • Suicide Prevention
  • Young Adult


  • Antipsychotic Agents