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.
Has parts
Paper I: Strømme MF, Mellesdal LS, Bartz-Johannesen C, Kroken RA, Krogenes M, Mehlum L, Johnsen E. Mortality and non-use of antipsychotic drugs after acute admission in schizophrenia: A prospective total-cohort study. Schizophr Res. 2021 Sep;235:29-35. The article is available at: https://hdl.handle.net/11250/2779688Paper II: Strømme MF, Mellesdal LS, Bartz-Johannesen CA, Kroken RA, Krogenes ML, Mehlum L, Johnsen E. Use of Benzodiazepines and Antipsychotic Drugs Are Inversely Associated With Acute Readmission Risk in Schizophrenia. J Clin Psychopharmacol. 2022 Jan-Feb 01;42(1):37-42. The article is available at: https://hdl.handle.net/11250/2996869
Paper III: Strømme MF, Bartz-Johannesen CA, Kroken RA, Mehlum L, Johnsen E. Overactive, aggressive, disruptive and agitated behavior associated with the use of psychotropic medications in schizophrenia. Schizophr Res. 2022 Oct;248:35-41. The article is available at: https://hdl.handle.net/11250/3018438