Mortality and non-use of antipsychotic drugs after acute admission in schizophrenia: A prospective total-cohort study

Strømme, Maria Fagerbakke; Mellesdal, Liv; Bartz-Johannesen, Christoffer; Kroken, Rune A.; Krogenes, Marianne L; Mehlum, Lars; Johnsen, Erik

doi:10.1016/j.schres.2021.07.009

Cited by 18 publications

(10 citation statements)

References 49 publications

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“…An initial search retrieved 8,345 abstracts; removal of duplicates resulted in 6,390 abstracts for review. Of these, a total of 135 studies 5‐10,38‐166 were included, after excluding 463 articles upon full text assessment (see Figure 1, Table 1 and supplementary information). We ultimately included 4,536,447 individuals with schizophrenia who were compared with 1,115,600,059 control subjects from the general population.…”

Section: Resultsmentioning

confidence: 99%

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Correll

Solmi

Croatto³

et al. 2022

World Psychiatry

297

169

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People with schizophrenia die 15‐20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random‐effects meta‐analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all‐cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific‐cause mortality. Publication bias, subgroup and meta‐regression analyses, and quality assessment (Newcastle‐Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all‐cause mortality was increased in people with schizophrenia versus any non‐schizophrenia control group (RR=2.52, 95% CI: 2.38‐2.68, n=79), with the largest risk in first‐episode (RR=7.43, 95% CI: 4.02‐13.75, n=2) and incident (i.e., earlier‐phase) schizophrenia (RR=3.52, 95% CI: 3.09‐4.00, n=7) versus the general population. Specific‐cause mortality was highest for suicide or injury‐poisoning or undetermined non‐natural cause (RR=9.76‐8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79‐7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio‐cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All‐cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001‐0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all‐cause and suicide‐related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide‐related mortality risk in incident schizophrenia samples. All‐cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all‐cause mortality (RR=1.62, 95% CI: 1.47‐1.80, n=3). Antipsychotics were protective against all‐cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59‐0.84, n=11), with largest effects for second‐generation long‐acting injectable antipsychotics (SGA‐LAIs) (RR=0.39, 95% CI: 0.27‐0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34‐0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39‐0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44‐0.63, n=4). Antipsychotics were also protective against natural cause‐related mortality, yet first‐generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust ...

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Section: Resultsmentioning

confidence: 99%

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Correll

Solmi

Croatto³

et al. 2022

World Psychiatry

297

169

View full text Add to dashboard Cite

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“…Research has shown that family members caring for relatives with schizophrenia experience a high level of objective and subjective burdens [ 47 ]. Additionally, scholarship suggests a higher degree of relapse and mortality when patients discontinue anti-psychotic medication [ 48 ]. Hence, the therapists worried this burden would increase when patients chose to discontinue medication.…”

Section: Discussionmentioning

confidence: 99%

How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway

Oedegaard

Ruano

Blindheim

et al. 2022

Int J Ment Health Syst

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Background Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment. Methods We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation. Findings Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening. Conclusions Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work. Trial registration: N/A.

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“…Cumulative exposure to antipsychotics that may impact mortality rates were not captured in our study. Finally, drug adherence is one of the major determinants of prognosis in schizophrenia with treatment gaps associated with relapse, hospitalization, suicide attempts, and mortality [12,21,22]. The measurement of adherence is difficult [23], and the NHIRD claims database is unable to capture short treatment gaps, particularly for users of oral antipsychotic, and we were unable to adjust for nonadherence in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Risks of all-cause death and completed suicide in patients with schizophrenia/schizoaffective disorder treated with long-acting injectable or oral antipsychotics: A population-based retrospective cohort study in Taiwan

et al. 2021

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Background: Long-acting injectable (LAI) antipsychotics improve medication adherence in patients with schizophrenia and provide an extended duration of therapeutic drug levels but with administration of an increased dose. Real-world mortality data in patients prescribed LAIs are lacking. We conducted a population-based cohort study to estimate and compare the incidence rates of all-cause death and completed suicide in patients with schizophrenia/schizoaffective disorder exposed to LAIs and oral antipsychotics. Methods: Patients with a diagnosis of schizophrenia/schizoaffective disorder between 01-Jan-2015 and 30-Nov-2019 were enrolled from the Taiwan National Health Insurance Research Database and linked to Death Registry records. Eligible patients were new antipsychotic users.Relative risks of death for each antipsychotic in comparison with oral paliperidone were evaluated using a Cox proportional hazard model adjusted for age, sex, Charlson Co-morbidity Index, index year, bipolar or major depressive or other mood disorders, and mental disorders due to drug use, and frequency of hospitalization during the baseline period.Results: There were 228,791.08 person-years of follow-up (mean follow up time 2.48 years ).The incidence rate of all-cause death in users of LAI paliperidone administered monthly (PP1M) and every 3 months (PP3M) was 7.40 per 1000 person-years (95% confidence interval 5. 94-9.11) and 9.93 (5.88-15.79), respectively. The incidence of completed suicide was 2.03 per 1000 person-years (1.32-2.99), and 3.10 (1.14-6.88), respectively. No significant associations were observed between PP1M or PP3M compared to oral paliperidone in terms of the incidence of allcause death or for completed suicide.Discussion: No increased risk of all-cause death or completed suicide was observed in users of antipsychotics LAIs, including PP1M and PP3M.

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Mortality and non-use of antipsychotic drugs after acute admission in schizophrenia: A prospective total-cohort study

Cited by 18 publications

References 49 publications

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway

Risks of all-cause death and completed suicide in patients with schizophrenia/schizoaffective disorder treated with long-acting injectable or oral antipsychotics: A population-based retrospective cohort study in Taiwan

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