Antipsychotic treatment and mortality in schizophrenia
#MMPMID25422511
Torniainen M
; Mittendorfer-Rutz E
; Tanskanen A
; Björkenstam C
; Suvisaari J
; Alexanderson K
; Tiihonen J
Schizophr Bull
2015[May]; 41
(3
): 656-63
PMID25422511
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BACKGROUND: It is generally believed that long-term use of antipsychotics
increases mortality and, especially, the risk of cardiovascular death. However,
there are no solid data to substantiate this view. METHODS: We identified all
individuals in Sweden with schizophrenia diagnoses before year 2006 (N = 21 492),
aged 17-65 years, and persons with first-episode schizophrenia during the
follow-up 2006-2010 (N = 1230). 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. RESULTS: Compared with age- and gender-matched controls from
the general population (N = 214920), the highest overall mortality was observed
among patients with no antipsychotic exposure (hazard ratio [HR] = 6.3, 95% CI:
5.5-7.3), ie, 0.0 defined daily dose (DDD)/day, followed by high exposure (>1.5
DDD/day) group (HR = 5.7, 5.2-6.2), low exposure (<0.5 DDD/day) group (HR = 4.1,
3.6-4.6), and moderate exposure (0.5-1.5 DDD/day) group (HR = 4.0, 3.7-4.4). High
exposure (HR = 8.5, 7.3-9.8) and no exposure (HR = 7.6, 5.8-9.9) were associated
with higher cardiovascular mortality than either low exposure (HR = 4.7, 3.7-6.0)
or moderate exposure (HR = 5.6, 4.8-6.6). The highest excess overall mortality
was observed among first-episode patients with no antipsychotic use (HR = 9.9,
5.9-16.6). CONCLUSIONS: 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.
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