Managing Suicidal Risk in Patients Taking Brexpiprazole

Pre-Treatment Risk Assessment and Intervention

The American College of Physicians, as reported in the Annals of Internal Medicine, recommends conducting a comprehensive suicide risk assessment, including self-directed violence history, current psychiatric conditions, access to lethal means, social determinants, and physical health conditions, before initiating brexpiprazole in patients with suicidal history 1
The Annals of Internal Medicine suggests using validated screening tools, such as the Columbia Suicide Severity Rating Scale Screener, Beck Scale for Suicidal Ideation, and Patient Health Questionnaire-9, to assess suicide risk in patients taking brexpiprazole 1, 2

The Annals of Internal Medicine recommends initiating cognitive behavioral therapy (CBT) focused on suicide prevention immediately upon starting brexpiprazole in patients with suicidal history, which can reduce suicide attempts by 32% in adults with recent suicidal behavior 1, 2
CBT should target suicidal thoughts, develop alternative coping strategies, and occur weekly initially for patients with suicidal behavior within the past 6 months, as suggested by the Annals of Internal Medicine and Praxis Medical Insights 1, 3, 4

The Annals of Internal Medicine and Praxis Medical Insights recommend implementing mandatory safety interventions, including removing all lethal means, establishing third-party medication monitoring, and developing a written crisis response plan, to reduce suicide risk in patients taking brexpiprazole 1, 3, 4
The American College of Physicians, as reported in the Annals of Internal Medicine, advises against using "no-suicide contracts" as they have no empirical evidence and create false reassurance 4

The Annals of Internal Medicine and Praxis Medical Insights suggest monitoring patients weekly for emergence or worsening of suicidal ideation, clinical worsening of depression, and behavioral changes during the initial 4 weeks of brexpiprazole treatment 1, 3, 4
The monitoring frequency can be adjusted to bi-weekly appointments from weeks 5-12 and monthly appointments from months 4-12, with systematic suicidal ideation screening at every visit, as recommended by Praxis Medical Insights 4

The Annals of Internal Medicine recommends considering ketamine infusion for rapid reduction of suicidal ideation in patients with major depressive disorder, although the evidence is weak and insufficient for reducing actual attempts 1, 3
The American College of Physicians, as reported in the Annals of Internal Medicine, suggests considering clozapine to reduce suicide attempt risk in patients with schizophrenia or schizoaffective disorder and suicidal ideation 1

Praxis Medical Insights recommends implementing periodic caring communications, such as postal mail or text messages, for 12 months following any crisis or hospitalization to reduce suicide attempt risk 3