Polypharmacy With Antipsychotics, Antidepressants, or Benzodiazepines and Mortality in Schizophrenia

Tiihonen, Jari

doi:10.1001/archgenpsychiatry.2011.1532

Cited by 216 publications

(163 citation statements)

References 36 publications

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“…Given that a large proportion of patients with psychotic illness are also exposed to antidepressants and benzodiazepines (5), it is somewhat surprising that the consequences of cumulative exposure to these medications have not drawn much attention. Thus far, one study has investigated mortality and current antidepressant use in schizophrenia (6), reporting a significantly decreased risk for suicide and a nonsignificant relationship between overall mortality during current antidepressant use compared with no use. To date, the relationship between benzodiazepine use and mortality has been studied in two publications (6,7).…”

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confidence: 99%

“…Thus far, one study has investigated mortality and current antidepressant use in schizophrenia (6), reporting a significantly decreased risk for suicide and a nonsignificant relationship between overall mortality during current antidepressant use compared with no use. To date, the relationship between benzodiazepine use and mortality has been studied in two publications (6,7). In both studies, current benzodiazepine use was associated with an increase of 80%290% in mortality.…”

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confidence: 99%

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Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study

Tiihonen

Mittendorfer‐Rutz

Torniainen

et al. 2016

AJP

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178

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Objective: Although mortality related to psychotropic medications has received much attention in recent years, little is known about the relationship between risk of death and cumulative antipsychotic load, and even less about the relationship between mortality and cumulative exposure to antidepressants or benzodiazepines. The authors examined these relationships using nationwide databases. Method:The authors used prospectively collected nationwide databases to identify all individuals 16-65 years of age with a schizophrenia diagnosis (N=21,492) in Sweden. All-cause and cause-specific mortality rates were calculated as a function of cumulative low, moderate, and high exposure to antipsychotics, antidepressants, and benzodiazepines from 2006 through 2010.Results: Compared with no exposure, both moderate (adjusted hazard ratio=0.59, 95% CI=0.49-0.70) and high (adjusted hazard ratio=0.75, 95% CI=0.63-0.89) antipsychotic exposures were associated with substantially lower overall mortality. Moderate antidepressant exposure was associated with a lower mortality (adjusted hazard ratio=0.85, 95% CI=0.73-0.98), and high exposure, even lower (adjusted hazard ratio=0.71, 95% CI=0.59-0.86). Exposure to benzodiazepines showed a dose-response relationship with mortality (hazard ratios up to 1.74 [95% CI=1.50-2.03]).Conclusions: Moderate and high-dose antipsychotic and antidepressant use were associated with 15%-40% lower overall mortality, whereas chronic high-dose use of benzodiazepines was associated with up to a 70% higher risk of death compared with no exposure. Since patients with anxiety and depressive symptoms may have a higher intrinsic risk of death, the finding for benzodiazepines may be attributable to some extent to residual confounding.

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mentioning

confidence: 99%

mentioning

confidence: 99%

Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study

Tiihonen

Mittendorfer‐Rutz

Torniainen

et al. 2016

AJP

Self Cite

178

137

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“…Al inferir sobre las enfermedades asociadas a partir de la 'comedicación' prescrita, se encontró que la depresión y los trastornos de ansiedad, son las más prevalentes, 32,5 % y 26,0 %, respectivamente, cifras similares a las encontradas en otros estudios (26,27). Se deben tener en cuenta las potenciales interacciones con los antidepresivos, ya que algunos de estos pueden prolongar el intervalo QT y producir muerte súbita cardiaca en los pacientes con antecedentes de riesgo cardiovascular, y provocar mayores efectos de tipo anticolinérgico, principalmente los antidepresivos tricíclicos (26).…”

Section: Discussionunclassified

“…Se deben tener en cuenta las potenciales interacciones con los antidepresivos, ya que algunos de estos pueden prolongar el intervalo QT y producir muerte súbita cardiaca en los pacientes con antecedentes de riesgo cardiovascular, y provocar mayores efectos de tipo anticolinérgico, principalmente los antidepresivos tricíclicos (26). La evaluación de la relación riesgo-beneficio de esta asociación, debe contemplar que los antidepresivos parecen reducir el riesgo de suicidio en los pacientes psicóticos, en contraste con la 'comedicación' de ansiolíticos, que lo aumenta (27).…”

Section: Discussionunclassified

Patrones de prescripción de antipsicóticos en pacientes afiliados al Sistema de Seguridad Social en Salud de Colombia

Machado‐Alba

Morales-Plaza

2013

biomedica

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Introducción. La esquizofrenia altera la percepción del individuo, el pensamiento, el afecto y el comportamiento. El tratamiento farmacológico puede mejorar estas manifestaciones. Objetivo. Determinar los patrones de prescripción de medicamentos antipsicóticos en un grupo de pacientes afilados al Sistema General de Seguridad Social en Salud de Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo sobre base de datos de 6,2 millones de personas. Se seleccionaron los pacientes medicados con antipsicóticos, de ambos sexos, todas las edades, con tratamiento continuo de marzo a junio de 2012, y residentes de 57 ciudades colombianas. Se diseñó una base de datos sobre consumo de medicamentos, obtenidos por la empresa que dispensa dichos fármacos. Resultados. Se estudiaron 3.075 pacientes con edad promedio de 55,8±21,5 años; 50,3 % eran mujeres; 81,9 % recibían monoterapia y, 18,1 %, dos o más antipsicóticos. El orden de prescripción fue: atípicos, 77,1 %, y clásicos, 31,9 %. Los medicamentos más utilizados fueron: quetiapina (30,3 %), clozapina (23,7 %), levomepropamiza (18,4 %) y risperidona (14,9 %). Las combinaciones más frecuentes fueron: haloperidol más levomepromazina (n=67; 12,1 % de las asociaciones), clozapina más pipotiazina (n=54; 9,7 %) clozapina más risperidona (n=45; 8,1 %), quetiapina más levomepromazina (n=40; 7,2 %). Los medicamentos prescritos concomitantemente más frecuentes fueron: antidepresivos (n=998; 32,5 %); ansiolíticos (n=799; 26,0 %); hipolipemiantes (n=672; 21,9 %); antiparkinsonianos (341; 11,1 %) y antidiabéticos (n=327; 10,6 %). Conclusiones. Predominan los hábitos de prescripción de medicamentos de alto valor terapéutico, principalmente en la monoterapia antipsicótica. En la mayoría, se emplean en dosis superiores a las recomendadas. Se plantea la necesidad de diseñar estrategias educativas para corregir algunos hábitos de prescripción e investigaciones que evalúen la efectividad del tratamiento.Palabras clave: esquizofrenia, prescripciones de medicamentos, antipsicóticos, clozapina, haloperidol, farmacoepidemiología, Colombia. doi: http://dx.doi.org/10.7705/biomedica.v33i3.1529 Antipsychotic prescription patterns in patients affiliated to the Social Security Health System in ColombiaIntroduction: Schizophrenia alters individual perception, thought, affection and behavior. Drug therapy can improve these manifestations. Objective: To determine prescription patterns of antipsychotic drugs in a group of patients affiliated to the Social Security Health System in Colombia. Materials and methods:This was a descriptive study with a 6.2 million people database. We selected 3,075 patients medicated with antipsychotics, of both sexes, and all ages, with continuous treatment from March to June, 2012, and residing in 57 Colombian cities. We designed a database on drug consumption, obtained by the company that distributes the drugs to the patients. Results: A total of 3,075 patients were studied, with an age mean of 55.8 ± 21.5 years; 50.3% of the participants were women. Of all pa...

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“…Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia (5).…”

Section: Williams and Rajapaksementioning

confidence: 99%

Update on therapeutics

Williams

Rajapakse

2013

Sri Lanka J. Psyc.

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This is a systematic review and meta-analysis which aims to answer the question, are antipsychotics effective in preventing relapse for patients with schizophrenia? The primary outcome was relapse occuring between 7 and 12 months. Secondary outcomes include readmission, dropout, improvement of disease, death, violence or aggressive behaviour, adverse events, quality of life, satisfaction with care and employment.The Cochrane Schizophrenia Group's specialised register for reports published before Nov 11, 2008; and PubMed, Embase, and ClinicalTrials. gov for those before June 8, 2011 were searched. They also contacted pharmaceutical companies and searched the reference lists of included studies and previous reviews. Randomised trials of patients with schizophrenia continued on or withdrawn from any antipsychotic drug regimen after stabilisation were eligible. They used the random effects model for analysis and verified results for the primary outcome with a fixed effects model. Heterogeneity was investigated with subgroup and meta-regression analyses. The study was funded by the German ministry of education and research.They identified 116 suitable reports from 65 trials, with data for 6493 patients. Antipsychotic drugs significantly reduced relapse rates at 1 year (drugs 27% vs placebo 64%; risk ratio [RR] 0·40, 95% CI 0·33-0·49; number needed to treat to benefit [NNTB] 3, 95% CI 2-3). Fewer patients given antipsychotic drugs than placebo were readmitted (10% vs 26%; RR 0·38, 95% CI 0·27-0·55; NNTB 5, 4-9), but less than a third of relapsed patients had to be admitted. Limited evidence suggested better quality of life (standardised mean difference -0·62, 95% CI -1·15 to -0·09) and fewer aggressive acts (2% vs 12%; RR 0·27, 95% CI 0·15-0·52; NNTB 11, 6-100) with antipsychotic drugs than with placebo. Employment data were scarce and too few deaths were reported to allow significant differences to be identified. More patients given antipsychotic drugs than placebo gained weight (10%vs 6%; RR 2·07, 95% CI 2·31-3·25), had movement disorders (16%vs 9%; RR 1·55, 95% CI 1·25-1·93), and experienced sedation (13%vs 9%; RR 1·50, 95% CI 1·22-1·84). Substantial heterogeneity in size of effect was recorded. In subgroup analyses, number of episodes, whether patients were in remission, abrupt or gradual withdrawal of treatment, length of stability before trial entry, first-generation or second-generation drugs, and allocation concealment method did not significantly affect relapse risk. Depot preparations reduced relapse (RR 0·31, 95% CI 0·21-0·41) more than did oral drugs (RR 0·46, 95% CI 0·37-0·53 ); depot haloperidol (RR 0·14, 95% CI 0·04-0·55) and fluphenazine (RR 0·23, 95% CI 0·14-0·39) had had larger effects than other drugs. The effects of antipsychotic drugs were greater in two unblinded trials (0·26, 0·17-0·39) than in blinded trials (RR 0·42, 95% CI 0·35-0·51; p= 0·03). In a meta-regression, the difference between drug and placebo decreased with study length. This study strengthens current practice of maintenance treat...

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Polypharmacy With Antipsychotics, Antidepressants, or Benzodiazepines and Mortality in Schizophrenia

Cited by 216 publications

References 36 publications

Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study

Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study

Patrones de prescripción de antipsicóticos en pacientes afiliados al Sistema de Seguridad Social en Salud de Colombia

Update on therapeutics

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