Study Shows Benefits of Long-Term Antipsychotic Use for Patients With Schizophrenia

Long-term antipsychotic use is associated with substantially decreased mortality compared with no antipsychotic use, especially among patients treated with clozapine, according to a report in World Psychiatry, the journal of the World Psychiatric Association.

Moreover, long‐term antipsychotic use does not increase the likelihood that a patient will experience severe illness leading to hospitalization, wrote Heidi Taipale, Ph.D., of the Karolinska Institute in Sweden and colleagues.

People with schizophrenia have a shorter average life expectancy than the general population. Taipale and colleagues wanted to know if these differences may be partly due to adverse effects associated with antipsychotics, such as weight gain.

They used data from a Finnish national registry on 62,250 patients treated for schizophrenia between 1972 and 2014. Specifically, they analyzed the association between periods of antipsychotic use and no antipsychotic use with hospitalization and/or death.

Hospitalization was classified as either “somatic” hospitalization (all hospitalizations except psychiatric and cardiovascular hospitalizations) or “cardiovascular” hospitalization. Three causes of death were analyzed: all‐cause mortality, cardiovascular mortality, and suicide death.

There was no increased risk of somatic or cardiovascular hospitalization associated with periods of antipsychotic use compared with periods of non-use. Cardiovascular deaths, suicide deaths, and all‐cause deaths were significantly lower in patients using any antipsychotics compared with those using none and was lowest for those using clozapine. The cumulative mortality rates during 20-year follow‐up were 46.2% for non‐use, 25.7% for any antipsychotic use, and 15.6% for clozapine use, according to the report.

“Antipsychotics reduce symptoms of schizophrenia, and this may be a major factor for decreased suicide mortality,” the researchers wrote. “Relief of stress may also have a beneficial effect on cardiovascular mortality. Smoking and high blood pressure are among the most important risk factors for cardiovascular death, and antipsychotics, especially clozapine, decrease blood pressure and possibly also the rate of smoking.”

For related information, see the American Journal of Psychiatry article “On the Continued Benefit of Antipsychotics After the First Episode of Schizophrenia” and the Psychiatric Services article “Psychiatry’s Role in Improving the Physical Health of Patients With Serious Mental Illness: A Report From the American Psychiatric Association.”

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