A Rational Approach to Risk Management of Suicidality vs. Torsades de Pointes (TdP) in Relation to the Prescribing of Antipsychotic Medication

Risk-benefit analysis and management is a core responsibility of physicians during the process of formulating and implementing a comprehensive and effective treatment plan. This assumes particular importance when working with individuals diagnosed with schizophrenia who are confronted with a 5% lifetime risk of completed suicide, as well as the risk of Torsades de Pointes (TdP), a lethal tachydysrhytmia, as a result of antipsychotic medication management. However, the actual risk of such an event, based upon recent epidemiologic data, is less than one-sixth that of completed suicide. Consequently, due consideration must be given to these data while constructing the medication component of a biopsychosocial treatment plan, as avoidance or under-prescribing of antipsychotics places an individual with schizophrenia at greater risk of completed suicide than that of TdP.