Patients with first-episode psychosis have a lower risk of work disability during periods when taking antipsychotics compared with periods not taking the medications, a report published Thursday in The American Journal of Psychiatry has found. The data—obtained from multiple Swedish databases on patients aged 16 to 45 who received a first nonaffective psychosis diagnosis—revealed that long-acting injectable (LAI) formulations may be particularly beneficial with regard to work disability.
“Reducing work disability can reduce indirect costs of schizophrenia and enable patients to be involved in gainful employment and to experience a sense of accomplishment, a structure for daily routine, and the possibility of belonging to a social group through interactions with coworkers,” wrote Marco Solmi, M.D., Ph.D., of the University of Ottawa and colleagues.
The study included 21,551 people (average age 29; 61% male) who received a first nonaffective psychosis diagnosis (including schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders). The researchers compared work disability outcomes (sickness absence or disability pension) during periods when these patients were taking antipsychotics with periods when they were not between 2006 and 2016.
Nearly 46% of first-episode patients had work disability during the average length of follow-up of 4.8 years, according to the researchers. The risk of work disability was 35% lower during antipsychotic use compared with no use by the same individuals.
“The lowest adjusted hazard ratios emerged for long-acting injectable antipsychotics (aHR=0.46), oral aripiprazole (aHR=0.68), and oral olanzapine (aHR=0.68),” Solmi and colleagues wrote. “Long-acting injectables were associated with lower risk than olanzapine, the most commonly used oral antipsychotic (aHR=0.68).”
The researchers noted, “The mechanism through which antipsychotics are associated with better work functioning is currently unknown. We hypothesize that antipsychotics exert their action at least partially via their effect on positive symptoms, enabling psychosocial rehabilitation and/or return to functionality in a sizable subgroup of patients.”
For related information, see the Psychiatric News articles “LAI Antipsychotics Beat Oral Meds for Preventing Relapse, Hospitalization” and “Study Calculates Disability Caused by Schizophrenia.”
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