Wednesday, December 10, 2014

Mortality Associated With Antipsychotic Dosage Reveals U-Shaped Curve, Study Shows

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 and those with the highest antipsychotic use. That's the finding of a report on mortality associated with antipsychotic use appearing online in Schizophrenia Bulletin.

It has been generally believed that long-term use of antipsychotics increases mortality and, especially, the risk of cardiovascular death, but no solid data existed to substantiate this. So Swedish researchers identified all individuals in Sweden with schizophrenia diagnoses before year 2006 (N=21,492), aged 17–65 years, and individuals with first-episode schizophrenia during the follow-up, 2006–2010 (N=1,230). Patient information was prospectively collected through nationwide registers. Total and cause-specific mortalities were calculated as a function of cumulative antipsychotic exposure from January 2006 to December 2010.

They found that the highest excess overall mortality was observed among first-episode patients with no antipsychotic use compared with age- and gender-matched controls from the general population. This was followed by patients with high exposure to antipsychotic medication (greater than 1.5 DDD/day). Patients with low exposure (<0.5 DDD/day) and moderate exposure (0.5–1.5 DDD/day) had lower overall mortality. The high exposure and no exposure patients were associated with higher cardiovascular mortality than either low exposure or moderate exposure.

“These results indicate that both excess overall and cardiovascular mortality in schizophrenia is attributable to factors other than antipsychotic treatment when used in adequate dosages,” the researchers state.

For more information, see the Psychiatric News article, "Antipsychotics for Elderly Vary in Mortality Risk."

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