Current Antipsychotic Use Research Articles

Antipsychotic Treatment and the Occurrence of Venous Thromboembolism

To examine the association between antipsychotic use and venous thromboembolism (VTE) in a Taiwan population. We conducted a nested case-control study using the National Health Insurance Research Database in Taiwan. A total of 2,162 cases with VTE (defined as pulmonary embolism and infarction [ICD-9-CM-code: 415.1] or deep vein thrombosis [ICD-9-CM-codes: 451.1x, 451.81, or 453.8]) and 12,966 matched controls were identified from 2001 to 2010. Antipsychotic exposure status was measured, and potential confounding factors were adjusted for in the analyses. Conditional logistic regressions were applied to determine the effect of antipsychotic use on VTE. Current antipsychotic use was associated with an increased risk for VTE (adjusted odds ratio [AOR] = 1.52; 95% CI, 1.19-1.93). Among current antipsychotic users, new users had a higher risk of VTE (AOR = 3.26; 95% CI, 2.06-5.17), whereas the risk among continuous users was modest but not statistically significant (AOR = 1.18; 95% CI, 0.89-1.56). The results demonstrated an increased risk of VTE among subjects with current antipsychotic use. Antipsychotic drugs should be prescribed with caution and attention to the increased risk of VTE. The underlying mechanisms related to the effect of antipsychotics on VTE development warrant further investigation.

Comparative Safety of Antipsychotics: Another Look at the Risk of Diabetes

The association between the use of antipsychotics and diabetes mellitus (DM) is still unclear, as depicted by several conflicting reports. Our study aims to assess the risk of DM in new users of antipsychotics. Our nested case-control study used the Quebec Health Insurance Board databases. People in the source cohort were DM-free and had initiated an antipsychotic treatment. Subjects were cohort members who initiated an antidiabetic or had a diagnosis of DM during their follow-up period. Three variables were used to assess antipsychotic exposure: the antipsychotic used (any typical, clozapine, olanzapine, quetiapine, risperidone, or more than 1 drug); the number of 30-day periods of use; and antipsychotic use at index date (current or past). A paired multivariate logistic regression model was used to calculate adjusted odds ratios. Among the 88 467 people included in the cohort, 6109 subjects with DM were identified and were matched to 61 090 control subjects. New users of quetiapine were less likely to develop DM than new users of typical antipsychotics (OR, 0.89; 95% CI 0.81 to 0.99). The risk of DM was not statistically different across the atypical antipsychotics. A longer exposure to any antipsychotic (for each 30-day period, OR 1.009; 95% CI 1.006 to 1.011) and current use of antipsychotics (OR 1.26; 95% CI 1.17 to 1.36) were associated with DM. These results suggest that metabolic parameters of people exposed to antipsychotics should be monitored, irrespective of the drug taken, among the drugs available at the time of analysis.

Neuropsychological correlates of insight in obsessive–compulsive disorder

There are limited data on neuropsychological correlates of poor insight in obsessive-compulsive disorder (OCD). We hypothesize that poor insight may be associated with greater impairment in tasks of conflict resolution/response inhibition and possibly impairment in a task of verbal learning and memory. Insight and neuropsychological functions were assessed in 150 subjects with DSM-IV OCD. The neuropsychological data of 177 healthy control subjects were used for comparison. Insight score correlated significantly with the Stroop Interference Test for conflict resolution/response inhibition (P = 0.002), and showed trends for significance with the Controlled Oral Word Association (COWA) average for verbal fluency (P = 0.021) and delayed recall on the Auditory Verbal Learning Test (AVLT) for verbal memory (P = 0.015). On regression analysis, the AVLT delayed recall, the COWA average, the Matrix score, the Yale-Brown Obsessive-Compulsive Scale total score, and current antipsychotic use emerged as significant predictors of poorer insight. Poor insight is associated with greater impairments in conflict resolution/response inhibition, verbal memory, and fluency. Individuals with poorer insight may have difficulty in appropriately processing conflicting information, updating their memory with corrective information, and then accessing this corrective information to modify their irrational beliefs.

Antipsychotic medicines in Australian community practice: Effectiveness, adverse effects and quality of life for people with schizophrenia

Introduction Atypical antipsychotics are increasingly recommended as first-line treatments in international clinical guidelines. However, recent meta-analyses and effectiveness studies have found few differences between typicals and atypicals. We aimed to assess the use of atypical and typical antipsychotic medicines, their perceived effectiveness and tolerability, and associated health-related quality of life among Australian community patients with an established diagnosis of schizophrenia or related disorders. Methods A random sample of people with schizophrenia spectrum disorders (n = 83) attending four public mental health clinics, and their treating clinicians and family carers, completed questionnaires on the effectiveness, acceptability and side-effects of current, previous and early antipsychotic medicine. Medicine use was determined from clinical notes. The Assessment of Quality of Life, Drug Attitude Inventory and Friendship Scale were also used. Results A significant shift over time towards atypical medicine use was reported: 66% of current antipsychotic use. Perceived effectiveness, satisfaction and side-effects did not differ when comparing medicine type (typical/depot/atypical) for early, previous and current medicines used. Health-related quality of life was associated with reported side-effects, but not with current medicine type. Agreement was poor between patients, case managers and carers about medicine use. Discussion Consistent with recent effectiveness trials, the findings suggest that any differences in the experience of typical and atypical antipsychotics of patients with established illnesses are obscured in the complex setting of real-world practice. Further, poor agreement between patients, case managers and carers about medicine use may indicate that they each have different understandings of the medicines that are being used.

Antipsychotic Drugs and the Risk of Hyperglycemia in Older Adults Without Diabetes: A Population-Based Observational Study

To determine whether current antipsychotic use among older persons without diabetes is associated with a higher risk of hospital visits for hyperglycemia, as previous studies in this population have yielded conflicting results. A nested case-control study within a population-based cohort of persons aged 66 years or older without diabetes, who initiated antipsychotic therapy between April 1, 2002, and March 31, 2006. Cohort members were identified using health databases from Ontario, Canada, and were followed from treatment start until March 31, 2007. Cases were patients with a hospital visit (emergency department visit or hospital admission) for hyperglycemia. We matched each case with up to 10 controls. We compared the risk of hyperglycemia among current antipsychotic users to that of remote users (discontinued > 180 days). The cohort consisted of 44,121 subjects, mean age of 78.3 years, followed for a mean of 2.2 years. Compared to remote antipsychotic use, current treatment with any antipsychotic was associated with a significantly increased risk of hospital visits for hyperglycemia (adjusted odds ratio [aOR]: 1.52; 95% confidence interval [CI]: 1.07-2.17). The risk was elevated for both atypical (aOR: 1.44; 95% CI: 1.01-2.07) and typical (aOR: 2.86; 95% CI: 1.46-5.59) antipsychotic agents. Current use of either atypical or typical antipsychotic agents was associated with a significantly increased risk of hospital visits for hyperglycemia among older persons without diabetes. These findings highlight the need for close glucose monitoring during antipsychotic therapy in older populations.

Inflammation in psychotic disorders: A population-based study

We investigated inflammatory markers in psychotic disorders and their association with metabolic comorbidity, antipsychotic medication, smoking, alcohol use, physical condition, and mood. From the population-based Finnish Health 2000 study, we identified all persons with schizophrenia ( n = 45), other nonaffective psychosis (ONAP) ( n = 57), affective psychosis ( n = 37) and chose controls matched by age, sex, and region of residence. We found that persons with schizophrenia had significantly higher sIL-2Rα, IL-1RA and C-reactive protein (CRP), persons with ONAP significantly higher IL-1RA and CRP and persons with affective psychosis almost significantly higher TNF-α compared to their matched controls. Current antipsychotic use was associated with elevated IL-1RA and CRP. After taking metabolic and lifestyle-related variables that associated with inflammatory markers into account, only antipsychotic medication remained associated with elevated IL-1RA and TNF-α which are markers related to the activation of innate immune system. CRP was influenced by both antipsychotic medication and nonaffective psychosis. sIL-2Rα, a marker of T-cell activation, was associated with depressive symptoms, schizophrenia, and affective psychosis. We conclude that in persons with psychotic disorders, activation of mononuclear phagocyte system was mostly related to metabolic comorbidity and antipsychotic medication use, whereas T-cell activation had a more direct relationship with both psychotic disorders and depressive symptoms.

Use of Antipsychotics in the Treatment of Major Depressive Disorder in the U.S. Department of Veterans Affairs

Despite the recent U.S. Food and Drug Administration approval of aripiprazole as the first antipsychotic to be used as an adjunct to antidepressant medications in the treatment of major depressive disorder (MDD), information on the current use of antipsychotics in the treatment of MDD has not been available. Records of antipsychotic prescriptions for all U.S. Department of Veterans Affairs patients diagnosed with MDD (ICD-9 criteria), excluding those with comorbid schizophrenia, schizoaffective disorder, or bipolar disorder, in the fiscal year 2007 (N = 191,522) were examined. Descriptive statistics and generalized estimating equations (GEEs) were used to identify veterans' characteristics, measures of service use, and medical center characteristics that were associated with receipt of these medications and, among such users, with use of the lower doses suggested for MDD. Altogether, 20.6% of veterans with MDD received antipsychotic medications, and 43% of those who did received them at the higher doses recommended for schizophrenia. GEE models showed that younger age, male gender, psychiatric comorbidities, duration of diagnosed MDD, and more intensive mental health service use were all associated with greater likelihood of receiving antipsychotics and with less likelihood of receiving them at conventional antipsychotic doses. Antipsychotic medications were commonly used in the treatment of MDD prior to FDA approval, especially in the presence of comorbid mental illness and longer term MDD. Further research is needed to evaluate the long-term safety and efficacy of these medications in combination with antidepressants.

Temporal lobe volume in bipolar disorder: Relationship with diagnosis and antipsychotic medication use

Background We tested for differences in temporal lobe volume in bipolar disorder and the relationship between these volumes and psychotropic medication use. Methods 125 subjects with bipolar disorder and 87 comparison subjects with no psychiatric illness completed clinical interviews and 1.5T MRI brain scans. Temporal lobe volumes were manually traced and segmented into gray matter and white matter volumes using an automated process. General linear models examined the relationship between these volumes and diagnosis as the primary predictor with age, sex, education, and race as copredictors. Secondary analyses incorporated the use of psychotropic medication into the linear models, and parsimonious models developed through backwards regression. Results In initial models, subjects with bipolar disorder exhibited larger temporal lobe white matter bilaterally (left: F 1,211 = 2.86, p = 0.0047; right: F 1,211 = 3.25, p = 0.0014). Current antipsychotic use was significantly associated with larger bilateral temporal lobe white matter volumes (left: F 2,211 = 9.45, p = 0.0001; right: F 2,211 = 10.79, p < 0.0001), wherein bipolar subjects taking antipsychotics had larger volumes than bipolar subjects not taking antipsychotics or healthy comparison subjects. Temporal lobe gray matter volume was not significantly associated with diagnosis or medication use. Limitations Excluding subjects with substance use disorders may limit the study's generalizability. Conclusions These findings indicate that differences in temporal lobe white matter are associated with bipolar disorder and use of antipsychotic medications.

Association between medication and risk of suicide, attempted suicide and death in nationwide cohort of suicidal patients with schizophrenia

Mortality among schizophrenia patients is substantially higher than in the general population. The aim of this study was to investigate, in a nationwide cohort of suicidal schizophrenic individuals, how the risks of suicide, severe suicide attempts and death are associated with usage of antidepressant or antipsychotic treatment. The study population included all individuals in Finland who were hospitalised with a diagnosis of attempted suicide between 1 January 1997 and 31 December 2003, who also had at least one hospitalisation due to schizophrenia diagnosis (ICD-10 F20), and were at least 16 years old when the index hospitalisation began. Cox's proportional hazards modelling and Bayesian intensity estimation were used in the analysis. There were 1611 patients with a mean follow-up time of 4.3 years. Current use of antipsychotics was associated with decreased mortality due to suicide (HR 0.52, 95% CI 0.34-0.81, p = 0.004), but no significant decrease in mortality was observed during current use of antidepressants (0.66, 0.41-1.08, p = 0.099), when compared to past use. In more detailed analysis when current users were compared to non-users, olanzapine, and mixed use of antipsychotics, were associated with reduced all-cause mortality, and mixed use also with reduced risk of suicide mortality. Current use of citalopram was associated with decreased all-cause and suicide mortality. In a population of suicidal schizophrenic individuals antipsychotic medication, treatment was associated with lower mortality from suicide and all-causes. Antidepressive medication was associated with lower all-cause mortality when used in combination with antipsychotics.

Antipsychotic Drug Use and Risk of Pneumonia in Elderly People

To investigate the association between antipsychotic drug use and risk of pneumonia in elderly people. A nested case-control analysis. Data were used from the PHARMO database, which collates information from community pharmacies and hospital discharge records. A cohort of 22,944 elderly people with at least one antipsychotic prescription; 543 cases of hospital admission for pneumonia were identified. Cases were compared with four randomly selected controls matched on index date. Antipsychotic drug use in the year before the index date was classified as current, recent, or past use. No prescription for an antipsychotic in the year before the index date was classified as no use. The strength of the association between use of antipsychotics and the development of pneumonia was estimated using multivariate logistic regression analysis and expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Current use of antipsychotics was associated with an almost 60% increase in the risk of pneumonia (adjusted OR=1.6, 95% CI=1.3-2.1). The risk was highest during the first week after initiation of an antipsychotic (adjusted OR=4.5, 95% CI=2.8-7.3). Similar associations were found after exclusion of elderly people with a diagnosis of delirium. Current users of atypical agents showed a higher risk of pneumonia (adjusted OR=3.1, 95% CI=1.9-5.1) than users of conventional agents (adjusted OR=1.5, 95% CI=1.2-1.9). There was no clear dose-response relationship. Use of antipsychotics in elderly people is associated with greater risk of pneumonia. This risk is highest shortly after the initiation of treatment, with the greatest increase in risk found for atypical antipsychotics.

Hospital use of antipsychotic agents in 1989 and 1993: stable dosing with decreased length of stay

This study evaluated recent and current use of antipsychotics by psychiatric inpatients. Computer-based hospital pharmacy records identified prescriptions for antipsychotics in 1993. Medical records were reviewed to verify prescription and clinical data, and these were compared with similar data from 1989. In 1993, antipsychotics were prescribed for 299 (42%) of 709 hospitalized patients. Treatment usually started within 24 hours of admissions averaging 18 days. High-potency agents were used 2.4 times more frequently than low-potency drugs; 13% received clozapine. The mean chlorpromazine-equivalent daily dose, corrected for as-needed supplements, was 305 mg; peak doses were 32% higher. Doses of the most potent agents (fluphenazine and haloperidol) were only 22%-33% above the overall mean. Rarely were two neuroleptics given simultaneously, but cotreatment with an anticonvulsant (84% of patients, 92% of whom received valproate), a potent benzodiazepine (81%), lithium (70%), one CNS depressant (84%), or more (45%) was common. Doses averaged 20% higher for men, 42% lower at age > 50 years versus 20-30 years, and 53% greater for schizophrenia or schizoaffective disorder versus other conditions. Comparison with 1989 admissions (N = 50) averaging 73 days indicated few differences in use of neuroleptics or benzodiazepines but less frequent use of anticonvulsants and lithium. High-potency antipsychotic agents and clozapine were used most often in 1993; doses of high-potency agents were only slightly higher than doses of low-potency agents, but combinations with mood stabilizers were more common in 1993, when length of stay was one-fourth that in 1989.