Use and non-use of antipsychotics and other psychotropic drugs in schizophrenia

Abstract

Background: Little is known about health-related outcomes for patients with schizophrenia when comparing periods with use and non-use of antipsychotic drugs in a real-life setting. Current evidence is also limited for the use of other psychotropic drugs, including antidepressants, mood stabilizers and benzodiazepines.

Aims: To investigate the association between use of different classes of psychotropic drugs and mortality (paper Ⅰ), risk of acute psychiatric readmission (paper Ⅱ) and risk of acute psychiatric readmission with overactive, aggressive, disruptive or agitated behaviour (OADA) (paper Ⅲ).

Material and methods: A cohort study included all patients diagnosed with schizophrenia admitted to a psychiatric acute unit at Haukeland University Hospital in Bergen, Norway, during a 10-year period. Patients were followed until death (paper I), readmission (paper II) or readmission with OADA (paper III). Cox multiple regression analyses were conducted using antipsychotic drugs and other psychotropic drugs as time-dependent variables, and periods of use and non-use were compared within individual patients. Adjustments were made for gender, age at index admission, and excessive use of alcohol and illicit substances.

Results: Non-use of antipsychotics was associated with two-fold increased mortality risk compared to periods with use of antipsychotics (paper Ⅰ). Compared to non-use, periods with use of antipsychotic drugs and benzodiazepines were associated with decreased and increased readmission risk, respectively (paper II). The risk of readmission with OADA was negatively associated with the use of antipsychotic drugs and antidepressants, and positively associated with the use of benzodiazepines (paper III).

Conclusion: For patients with schizophrenia, periods with non-use of antipsychotic drugs was associated with increased risk of death, readmission and readmission with OADA. Periods with use of benzodiazepines were associated with increased risk of readmission and readmission with OADA.

Implications: We identified important modifiable risk factors associated with non-use of antipsychotic drugs and use of benzodiazepines that are directly or indirectly associated with mortality. This is important knowledge for patients facing decisions concerning use versus non-use of antipsychotic drugs, but also for the patients’ families and carers.