Structured diagnostic assessment and depot fluphenazine treatment of multiple suicide attempters in the emergency department

The aim of this study was to compare the efficacy of two doses of monthly i ntramuscular (i.m.) injections of fluphenazine decanoate in reducing self-h arm behaviours in outpatients with histories of multiple suicide attempts. Fifty-eight patients who presented to a psychiatric emergency service after an attempted suicide and who had histories of multiple suicide attempts, w ere randomized to receive monthly i.m, injections of fluphenazine decanoate . Thirty patients received monthly 12.5 mg ('low' dose), and 28 patients re ceived monthly 1.5 mg ('ultra low' dose) under double-blind conditions. DSM -III-R diagnoses were obtained on all patients using the Structured Clinica l Interview for DSM-III-R-Patient Version (SCID-P) and SCID for DSM-III-R P ersonality Disorders (SCID-II). Outcomes were assessed by the Parasuicide H istory Inventory and the Abnormal Involuntary Movement Scale, collected mon thly for 6 months. Patients had an average of six current Axis I and 2.6 Ax is II diagnoses, with borderline personality (85%) and alcohol dependence ( 58%) occurring most frequently in the sample. Both the low dose and ultra-l ow dose groups showed a marked reduction in self-harm behaviours. For 'seri ous' self harm behaviours, there was a trend for a greater effect of the lo w dose over the ultra-low dose group, however, the differences did not reac h statistical significance. A survival analysis indicated that the presence of 'acute' stressors at baseline and female sex were risk factors for cont inuing (post-randomization) 'serious' self-harm behaviours, while younger a ge and the absence of concurrent general medical conditions were risk facto rs for all self-harm behaviours. Int Clin Psychopharmacol 14:361-372 (C) 19 99 Lippincott Williams & Wilkins.