Antipsychotic Use Safer Than No Use in Schizophrenia

Among patients with schizophrenia, long-term antipsychotic use does not appear to increase severe physical morbidity or somatic hospitalization, and mortality is lower for antipsychotic use compared with no use, according to a study published online January in World Psychiatry.

Heidi Taipale, from the Karolinska Institutet in Stockholm, and colleagues assessed the risk for hospitalization due to physical health problems and the risk for mortality (all-cause, cardiovascular, or suicidal) among all patients treated for schizophrenia with antipsychotic agents in inpatient care in Finland during 1972 to 2014 (62,250 patients).

During a median follow-up of 14.1 years, the researchers found that the adjusted hazard ratio (aHR) for any somatic hospitalization was 1.00 (95 percent confidence interval [CI], 0.98 to 1.03) and the aHR for cardiovascular hospitalization was 1.00 (95 percent CI, 0.92 to 1.07) during use of any antipsychotic compared with nonexposure periods for the same individual. For all-cause mortality, the aHR was 0.48 (95 percent CI, 0.46 to 0.51), with 0.62 (95 percent CI, 0.57 to 0.67) for cardiovascular mortality and 0.52 (95 percent CI, 0.43 to 0.62) for suicide mortality during use versus nonuse of any antipsychotic. Specifically, with the use of clozapine, the aHR for all-cause mortality was 0.39 (95 percent CI, 0.36 to 0.43), with 0.55 (95 percent CI, 0.47 to 0.64) for cardiovascular and 0.21 (95 percent CI, 0.15 to 0.29) for suicide mortality. During follow-up, the cumulative mortality rates were 46.2 percent for no antipsychotic use, 25.7 percent for any antipsychotic use, and 15.6 percent for clozapine use.

"Building trust and understanding towards the efficacy and safety of antipsychotic drugs is important, and we hope that this study can contribute to this end," a coauthor said in a statement.

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