Hospitalization risk factors in antipsychotic-treated schizophrenia, bipolar I disorder or major depressive disorder

Yan, Tingjian; Greene, Mallik; Chang, Eunice; Broder, Michael S.; Touya, Maëlys; Munday, Jennifer; Hartry, Ann

doi:10.2217/cer-2018-0090

Cited by 7 publications

(5 citation statements)

References 53 publications

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“…Nine analyses from three studies [ 39 , 46 , 67 ] investigated the impact of diabetes (n = 5), cardiovascular disease (n = 2) and COPD (n = 2) on hospitalisation in a patient population with pre-existing schizophrenia (n = 2) or bipolar disorder (n = 7). The outcome was all-cause ED attendances for four studies and all-cause admissions for five.…”

Section: Resultsmentioning

confidence: 99%

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The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis

Launders¹,

Dotsikas²,

Marston³

et al. 2022

PLoS ONE

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Background People with severe mental illness (SMI) are at higher risk of physical health conditions compared to the general population, however, the impact of specific underlying health conditions on the use of secondary care by people with SMI is unknown. We investigated hospital use in people managed in the community with SMI and five common physical long-term conditions: cardiovascular diseases, COPD, cancers, diabetes and liver disease. Methods We performed a systematic review and meta-analysis (Prospero: CRD42020176251) using terms for SMI, physical health conditions and hospitalisation. We included observational studies in adults under the age of 75 with a diagnosis of SMI who were managed in the community and had one of the physical conditions of interest. The primary outcomes were hospital use for all causes, physical health causes and related to the physical condition under study. We performed random-effects meta-analyses, stratified by physical condition. Results We identified 5,129 studies, of which 50 were included: focusing on diabetes (n = 21), cardiovascular disease (n = 19), COPD (n = 4), cancer (n = 3), liver disease (n = 1), and multiple physical health conditions (n = 2). The pooled odds ratio (pOR) of any hospital use in patients with diabetes and SMI was 1.28 (95%CI:1.15–1.44) compared to patients with diabetes alone and pooled hazard ratio was 1.19 (95%CI:1.08–1.31). The risk of 30-day readmissions was raised in patients with SMI and diabetes (pOR: 1.18, 95%CI:1.08–1.29), SMI and cardiovascular disease (pOR: 1.27, 95%CI:1.06–1.53) and SMI and COPD (pOR:1.18, 95%CI: 1.14–1.22) compared to patients with those conditions but no SMI. Conclusion People with SMI and five physical conditions are at higher risk of hospitalisation compared to people with that physical condition alone. Further research is warranted into the combined effects of SMI and physical conditions on longer-term hospital use to better target interventions aimed at reducing inappropriate hospital use and improving disease management and outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Hospital Utilisation In People With Smi Comparing People Wit...mentioning

confidence: 99%

The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis

Launders¹,

Dotsikas²,

Marston³

et al. 2022

PLoS ONE

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“…While this study was not designed to assess the specific causes of increased hospitalization, prior research found that hospitalization following the use of AAPs is driven by several known risk factors such as age, sex, drug formulation [e.g., oral vs. long-acting injectable (LAI)], non-adherence, and living in a supervised setting ( 15 ). The current study found that older adults generally had higher RORs of hospitalization than younger adults partly because AAPs are associated with potentially serious AEs in vulnerable older adults due to age-related reduction in the ability to metabolize and excrete drugs ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Comparative Safety Signal Assessment of Hospitalization Associated With the Use of Atypical Antipsychotics

et al. 2022

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BackgroundPersons with symptoms of psychosis receiving treatment with atypical antipsychotics (AAPs) can experience serious adverse events (AEs) requiring admission to the hospital. The comparative likelihood of AE-related hospitalization following the use of all AAPs has not been fully characterized. Therefore, we evaluated the safety signals of hospitalizations associated with the use of AAPs.MethodsWe conducted a cross-sectional analysis using the FDA Adverse Event Reporting System (FAERS) database (from January 1, 2004, to December 31, 2021) to examine disproportionality in reporting hospitalizations suspected to be associated with 12 AAPs (aripiprazole, asenapine, brexpiprazole, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, and pimavanserin, quetiapine, risperidone, and ziprasidone). Hospitalization in the FAERs database is an outcome that is recorded as a result of an AE occurring at any drug dose. We estimated reporting odds ratios (RORs) by comparing the odds of hospitalization occurring with a particular AAP to the odds of its occurrence with other drugs. In addition, we considered the presence of a significant safety signal when the lower limit of the 95% confidence interval (CI) of the ROR is >1.ResultsA total of 204,287 cases of hospitalizations were reported to the FDA for individuals treated with AAPs. There were significant safety signals of hospitalization associated with using clozapine (ROR, 2.88; 95% CI, 2.84–2.92), olanzapine (ROR, 2.61; 95% CI, 2.57–2.64), quetiapine (ROR, 1.87; 95% CI, 1.85–1.89), risperidone (ROR, 1.41; 95% CI, 1.39–1.43), aripiprazole (ROR, 1.34; 95% CI, 1.32–1.35), and ziprasidone (ROR, 1.14; 95% CI, 1.10–1.18). However, no hospitalization-related safety signals were observed with the use of paliperidone, pimavanserin, iloperidone, asenapine, lurasidone, and brexpiprazole. The ROR estimates were numerically higher among older adults than younger adults.ConclusionsThis cross-sectional assessment of data from FAERs (2004–2021) suggested that users of clozapine, olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone were more likely to report being hospitalized than users of other AAPs. Given that the FAERs database only contains spontaneous reports of AEs experienced by persons exposed to a drug but without information on exposed persons who did not have an event, a cohort study comparing hospitalizations among new users of individual AAPs against each other is needed to delineate these safety signals further.

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“… 1 , 45 Psychiatric hospital admission among patients with SCZ is associated with younger age; prior hospital admission; and comorbidities such as substance misuse, depression, anxiety and personality disorders. 46 Annual hospital admission rates range from approximately 23 to 27% in recent literature. 46 , 47 In our study, the annual psychiatric hospital admission rate was only 7%.…”

Section: Discussionmentioning

confidence: 99%

“… 46 Annual hospital admission rates range from approximately 23 to 27% in recent literature. 46 , 47 In our study, the annual psychiatric hospital admission rate was only 7%. Older patient age might have contributed to the low hospital admission rate, but it is also likely that patient selection for CABG favours those with fewer psychiatric symptoms and better overall psychosocial functioning.…”

Section: Discussionmentioning

confidence: 99%

Impaired long-term outcomes of patients with schizophrenia spectrum disorder after coronary artery bypass surgery: nationwide case–control study

et al. 2022

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Background Patients with schizophrenia spectrum disorder have increased risk of coronary artery disease. Aims To investigate long-term outcomes of patients with schizophrenia spectrum disorder and coronary artery disease after coronary artery bypass grafting surgery (CABG). Method Data from patients with schizophrenia spectrum disorder (n = 126) were retrospectively compared with propensity-matched (1:20) control patients without schizophrenia spectrum disorder (n = 2520) in a multicentre study in Finland. All patients were treated with CABG. The median follow-up was 7.1 years. The primary outcome was all-cause mortality. Results Patients with diagnosed schizophrenia spectrum disorder had an elevated risk of 10-year mortality after CABG, compared with control patients (42.7 v. 30.3%; hazard ratio 1.56; 95% CI 1.13–2.17; P = 0.008). Schizophrenia spectrum diagnosis was associated with a higher risk of major adverse cardiovascular events during follow-up (49.9 v. 32.6%, subdistribution hazard ratio 1.59; 95% CI 1.18–2.15; P = 0.003). Myocardial infarction (subdistribution hazard ratio 1.86; P = 0.003) and cardiovascular mortality (subdistribution hazard ratio 1.65; P = 0.017) were more frequent in patients with versus those without schizophrenia spectrum disorder, but there was no difference for stroke. Psychiatric ward admission, antipsychotic medication, antidepressant use and benzodiazepine use before CABG were not associated with outcome differences. After CABG, patients with schizophrenia spectrum disorder received statin therapy less often and had lower doses; the use of other cardiovascular medications was similar between schizophrenia spectrum and control groups. Conclusions Patients with schizophrenia spectrum disorder have higher long-term risks of death and major adverse cardiovascular events after CABG. The results underline the vulnerability of these patients and highlight the importance of intensive secondary prevention and risk factor optimisation.

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Hospitalization risk factors in antipsychotic-treated schizophrenia, bipolar I disorder or major depressive disorder

Cited by 7 publications

References 53 publications

The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis

The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis

Comparative Safety Signal Assessment of Hospitalization Associated With the Use of Atypical Antipsychotics

Impaired long-term outcomes of patients with schizophrenia spectrum disorder after coronary artery bypass surgery: nationwide case–control study

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