Antipsychotic Treatment and Mortality in Schizophrenia

Abstract

Among patients with schizophrenia, the cumulative antipsychotic exposure displays a U-shaped curve for overall mortality, revealing the highest risk of death among those patients with no antipsychotic use. These results indicate that both excess overall and cardiovascular mortality in schizophrenia is attributable to other factors than antipsychotic treatment when used in adequate dosages.

Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study

“…We used nationwide register data to conduct a prospective population-based cohort study of patients with schizophrenia, as previously described (2). This research project was approved by the Regional Ethics Board of Stockholm (decision 2007/762-31).…”

“…Next, we divided the sum by the length of follow-up in days, of which the days spent in a hospital were subtracted, because antipsychotic medications that may be used in hospitals are not recorded in the Prescribed Drug Register. The identified schizophrenia patients were categorized into four DDD groups: 1) no antipsychotics, antidepressants, or benzodiazepines during the follow-up, 2) small doses or occasional use (0-0.5 DDD/day, noninclusive), 3) moderate doses (0.5-1.5 DDD/day, inclusive), and 4) high doses (.1.5 DDD/day), as in our previous study (2). For example, one DDD is 5 mg for risperidone, 20 mg for fluoxetine, and 10 mg for diazepam.…”

“…To study the putative survival bias, we also conducted a sensitivity analysis among first-episode patients. This cohort has been described in detail previously (2).…”

“…Especially in Europe, public media have widely claimed that the shorter life expectancy of patients is attributable to long-term exposure to antipsychotics and that the use of such medications should be avoided whenever possible (1). Thus far, only two published studies have described the relationship between risk of death and cumulative antipsychotic dose in representative patient populations (2,3), but those studies did not control for the effect of concomitant psychotropic medications. Another study investigated cardiac mortality and cumulative exposure to antipsychotics (4), but it included only patients who had more than one prescription for oral thioridazine, haloperidol, risperidone, or clozapine.…”

Do adverse perinatal events predict mortality in schizophrenia during midlife?

“…Suggested reasons for excess mortality are unhealthy lifestyle (Connolly and Kelly 2005;Laursen et al 2012;Ringen et al 2014;Suvisaari et al 2013) and use (Joukamaa et al 2006) or non-use of antipsychotics (Tiihonen et al 2016;Torniainen and et al 2015). Studies have mainly focused on predictors of mortality prevalent in the later stages of life (Fazel et al 2014;Joukamaa et al 2006;Suvisaari et al 2013;Tiihonen et al 2016) reporting that self-harm, alcohol/drug use disorders (Fazel et al 2014), older age at onset of schizophrenia, long duration of illness and inability to work are predictors of mortality (Ran et al 2007).…”