Duration Of Antipsychotic Use Research Articles

Association between antipsychotic medication and clinically relevant weight change: meta-analysis.

Previous meta-analyses have shown that almost all antipsychotics are associated with weight gain. However, mean weight gain is not informative about clinically relevant weight gain or weight loss. To provide further insight into the more severe body weight changes associated with antipsychotic use, we assessed the proportion of patients with clinically relevant weight gain (CRWG) and clinically relevant weight loss (CRWL), defined as ≥7% weight gain and ≥7% weight loss. We searched PubMed, Embase and PsycInfo for randomised controlled trials of antipsychotics that reported CRWG and CRWL in study populations aged 15 years or older. We conducted meta-analyses stratified by antipsychotic and study duration using a random-effects model. We performed meta-regression analyses to assess antipsychotic-naive status and psychiatric diagnosis as modifiers for CRWG. PROSPERO: CRD42020204734. We included 202 articles (201 studies). Almost all included antipsychotics were associated with CRWG. For CRWL, available data were too limited to draw firm conclusions. For some antipsychotics, CRWG was more pronounced in individuals who were antipsychotic-naive than in individuals switching to another antipsychotic. Moreover, a longer duration of antipsychotic use was associated with more CRWG, but not CRWL. For some antipsychotics, CRWG was higher in people diagnosed with schizophrenia, but this was inconsistent. Switching antipsychotic medication is associated with both weight gain and weight loss, but the level of CRWG is higher than CRWL in antipsychotic-switch studies. CRWG was more pronounced in antipsychotic-naive patients, highlighting their vulnerability to weight gain. The impact of diagnosis on CRWG remains inconclusive.

Untreated OSA and Worsening Psychotic Symptoms in a Geriatric Patient with Schizophrenia: A Case Study

<h3>Introduction</h3> In addition to being a debilitating mental disorder, schizophrenia comes with a host of medical comorbidities, that can shorten the lifespan of those living with this illness by 10-25 years. Among these comorbidities is obstructive sleep apnea (OSA), which studies have shown to be more prevalent among patients with schizophrenia, even when controlling for gender, age, other comorbidities, and duration of antipsychotic use. The treatment of schizophrenia and its comorbidities in advanced age is an important consideration in geriatric psychiatry, as the number of patients living with schizophrenia over the age of 60 has been estimated to reach 10 million worldwide by 2050. However, there is limited research on the clinical management of OSA as a complication in geriatric patients with schizophrenia. Here we present the case of a patient with longstanding schizophrenia complicated by obstructive sleep apnea. <h3>Methods</h3> Patient was assessed and followed in a Veterans Hospital-associated long-term care facility by a geriatric psychiatry consultation-liaison service with the assistance of a multidisciplinary team. Here, we present the case and offer a review of the current literature surrounding schizophrenia and obstructive sleep apnea in the geriatric population. <h3>Results</h3> This is a case report of Mr. G, a 78-year-old man with a psychiatric history of schizophrenia and medical comorbidities of lymphedema, morbid obesity, and obstructive sleep apnea. Mr. G was diagnosed with schizophrenia in his early 20s during military service and was maintained on psychotropics for many years with a high degree of functioning, including being able to hold several "odd jobs" and live relatively independently. Throughout his life, Mr. G described baseline auditory hallucinations that were often a nuisance but disappeared when talking to others. As Mr. G got older, he sustained several injuries that made it more difficult for him to live independently, and he was moved into an ALF. Here, his course has been complicated by chronic obstructive sleep apnea likely precipitated by morbid obesity. The case is further complicated by the fact that Mr. G has an intense aversion to wearing masks and has failed multiple trials of CPAP mask. In this context, he has described a worsening of the auditory hallucinations in frequency and intensity, and also in his own affective response to the hallucinations- namely, he is more distressed by them now than he was as a young man. Furthermore, this change has not been responsive to titration in antipsychotics or psychotropic augmentation. <h3>Conclusions</h3> This case demonstrates the need for further research into the relationship between obstructive sleep apnea and schizophrenia, particularly in alternative clinical options. Multiple epidemiological studies have found that OSA is highly prevalent in patients with schizophrenia, and a recent pilot study found that treatment with CPAP improved cognition in patients with schizophrenia. Of particular interest, a recent retrospective case-control study showed similar adherence to CPAP between patients with schizophrenia and control groups. However, it must be noted that although adherence to CPAP was not markedly different from control groups, it was still only approximately 36% after the one-year mark, indicating the need for further development into treatment modalities and adherence measures for those living with schizophrenia, particularly in the geriatric population. <h3>This research was funded by</h3> No Funding Sources to Report

Assessment of the extrapyramidal side effects among psychosis patients consuming antipsychotic medication with a view to develop an information leaflet on early recognition and management of extrapyramidal side effects in SS selected hospital at Raipur

Introduction: Patients suffering from physical illnesses are given specific treatment because the causes are specific and the signs and symptoms are specific. The doctor generally knows how the treatment works, and the patient co-operates with the doctors, and nurses, in order to get better. In psychiatric hospital the treatment may not be so specific and most patients are given more than one treatment. The nurse has an extremely important role to play in the treatment of the mentally ill. Her actions, attitudes and skills to help him to deal with his problems are themselves an essential part of his treatment. Objectives: The main objective was to assess the extrapyramidal side effects among psychosis patients consuming antipsychotic medication. Secondary objective was to find out the association of extrapyramidal side effects with selected socio-demographic and clinical variables. Methodology: 60 psychosis patients attending outpatient and inpatient department of psychiatry in Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur, Chhattisgarh who receive antipsychotic medications were assessed for extrapyramidal side effect of antipsychotic drugs. The conceptual framework adopted for study was based on Health Belief Model. Modified Simpson Angus Scale (MSAS) was used to assess/measure extrapyramidal side effects. Patients scoring less than 3 were considered ‘normal’. Patients scoring 3 to 5 were considered having ‘minimal movement disorder’. Those scoring 6 to 11 have ‘clinically significant degree of movement disorder’. And those scoring 12 to 17 were present with ‘severe degree of movement disorder’. Result: It was observed that highest number of subjects i.e. 37 (66.66%) were ‘normal’. 11 subjects (18.33%) were with ‘minimal movement disorder’. 7 subjects (11.66%) were with ‘clinically significant extrapyramidal side effects. Only 5 subjects (8.33%) had severe degree of movement disorder. There was significant association of extrapyramidal side effects with duration of illness, duration of antipsychotic use and immediate side effect of antipsychotics at 0.05 level of significance. Conclusion: It was concluded in this study that extrapyramidal side effects may occur among patients consuming antipsychotic medication. Also significant relationship was found between extrapyramidal side effects with duration of illness, duration of antipsychotic use and immediate effect of antipsychotic medication (1-2 days observation).

Antipsychotics result in more weight gain in antipsychotic naive patients than in patients after antipsychotic switch and weight gain is irrespective of psychiatric diagnosis: A meta-analysis

Antipsychotics are associated with bodyweight gain and metabolic disturbance. Previous meta-analyses were limited to mainly antipsychotic switch studies in patients with a diagnosis of schizophrenia or psychosis with short follow-up periods. The present meta-analysis aimed to analyse the impact of weight change in antipsychotic-naive and antipsychotics switch patients and whether body weight change depended on diagnosis. We performed a meta-analysis of clinical trials of antipsychotics that reported weight change, irrespective of psychiatric diagnosis. Outcome measure was body weight change. Studies were classified into antipsychotic-naive and antipsychotic-switch. Forest plots stratified by antipsychotic and the duration of antipsychotic use were generated and results were summarised in figures. In total, 404 articles were included for the quantitative synthesis. 58 articles were on antipsychotic naive patients. In the antipsychotic naive group, all antipsychotics resulted in body weight gain. In the antipsychotic switch group, most antipsychotics likewise resulted in bodyweight gain, with exception of amisulpride, aripiprazole and ziprasidone that showed no body weight gain or even some weight loss after switching antipsychotics. Diagnosis was not a discriminating factor of antipsychotic induced weight change. Antipsychotic use resulted in substantial increase in body weight in antipsychotic-naive patients. In antipsychotic-switch patients the weight gain was mild and not present in amisulpride, aripiprazole and ziprasidone. In both groups, weight gain was irrespective of the psychiatric diagnosis.

Risk of obstructive sleep apnea in patients with schizophrenia: a nationwide population-based cohort study.

Patients with schizophrenia (SCZ) have a higher prevalence of known risk factors for obstructive sleep apnea (OSA). This study aims to determine if SCZ patients are at increased risk of incident OSA. A total of 5092 newly diagnosed SCZ patients and 5092 non-SCZ controls matched by gender, age, and index year were included between 2000 and 2012 and followed to 2013. Participants newly diagnosed with OSA were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence intervals (CI) of the OSA incidence rate between the two groups studied. SCZ patients were at increased risk of OSA compared to non-SCZ controls after adjusting for gender, age, comorbidities, and duration of antipsychotic use (2.12 versus 1.01 per 1000 person-years, HR: 1.97, 95% CI: 1.36-2.85). Also, this study confirmed the existence of some known risk factors for OSA, including male gender (HR 1.65, 95% CI 1.14-2.37), obesity (HR 2.62, 95% CI 1.19-5.80), hypertension (HR 1.61, 95% CI 1.06-2.47), hyperlipidemia (HR 1.55, 95% CI 1.04-2.38), diabetes (HR 1.53, 95% CI 1.01-2.38), and antipsychotic use (duration < 1year (HR 1.57, 95% CI 1.13-2.37), 1-3years (HR 1.62, 95% CI 1.06-2.82), and 3-5years (HR 1.45, 95% CI 1.06-2.44)). This study shows SCZ patients are at increased risk of OSA, and there is still an association with higher risk of OSA after controlling for known risk factors, indicating that it is necessary to develop targeted interventions in SCZ patients to reduce the negative impact of OSA on health.

Galactorrhea among Female Mentally Ill Patients Using Antipsychotics in a Tertiary Institution in South-South Nigeria

Objective was to determine the prevalence of galactorrhea among respondents, to determine the correlation between the dose of antipsychotic and the presence of galactorrhea, to determine the relationship between the duration of drug use and the prolactin level, to determine the relationship between class of antipsychotic and galactorrhea, and to determine the predictors of galactorrhea among the respondents. This is a cross-sectional study. From 81 consenting patients taking prescribed antipsychotic medications and all of whom have met the inclusion criteria, a sociodemographic interview schedule was administered. Next, the venous blood sample was collected for the estimation of the serum prolactin level. The prevalence of galactorrhea was 50.6%, there was a correlation between galactorrhea and chlorpromazine equivalent dose of antipsychotics (r = 0.356, p = 0.001), there is an association between galactorrhea and the use of typical antipsychotics, there was also an association between the duration of antipsychotic use and galactorrhea, and the greatest predictor of galactorrhea was found to be the duration of antipsychotic medication usage. Galactorrhea can result from the use of atypical or typical antipsychotics, and the duration of antipsychotic use was the greatest predictor of galactorrhea.

Impact of type and duration of use of antipsychotic drugs on plasma levels of selected acute-phase proteins in patients with major mental illnesses

Background: Disorders of the hemostatic system such as hypercoagulation and hypofibrinolysis are clinical manifestations in patients with schizophrenia, depression, and bipolar disorder. However, the role of the type of antipsychotic medication as well as the duration of use on disturbances in the hemostatic system is poorly understood. This study was, therefore, carried out to determine the possible impact of antipsychotic treatment as well as the duration of use on selected acute-phase proteins involved in coagulation and fibrinolysis. Materials and Methods: Plasma levels of fibrinogen and plasminogen activator inhibitor-1 (PAI-1) were determined in 124 patients with major mental illnesses: schizophrenia, depression, and bipolar disorder. Thereafter, the participants were grouped based on the type of antipsychotic medication (typical vs. atypical) and the duration of antipsychotic use. Results: Patients on typical antipsychotics had a slightly elevated level of PAI-1 but a similar level of fibrinogen when compared with patients on atypical antipsychotics. Furthermore, the median plasma levels of fibrinogen and PAI-1 in patients who have been on antipsychotic use for more than 10 years were slightly higher than in patients who have been on the drug for 10 years or less. Conclusion: It could be concluded from this study that patients on typical antipsychotics and those who have used any form of antipsychotics for more than 10 years might benefit from periodic assessment of markers of prothrombosis as it could facilitate early identification of those at risk of venous thromboembolism.

Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study

ObjectivesTo describe factors associated with initiating antipsychotics and patterns of persistence to antipsychotic therapy in a large cohort of adults with intellectual and developmental disabilities.DesignPopulation-based cohort study.SettingOntario, Canada.ParticipantsAdults with intellectual and developmental disabilities (IDD) in Ontario.Outcome measuresWe used multivariable logistic regression to investigate patient characteristics associated with antipsychotic initiation. Patient characteristics studied included sociodemographic characteristics, measures of clinical comorbidity and health service use.ResultsAmong 39 244 individuals eligible for this study, 6924 (17.6%) initiated an antipsychotic over the accrual window, of whom 1863 (26.9%) had no psychiatric diagnosis in the prior 2 years. A number of factors were significantly associated with antipsychotic initiation, including male gender, residence in a group home, prior use of benzodiazepines, antidepressants or cognitive enhancers, a recent emergency department visit or mental health hospitalisation and a visit to a psychiatrist or family physician in the prior 90 days. In a secondary analysis, the association between antipsychotic initiation and age, prior diagnosis of diabetes or myocardial infarction and polypharmacy differed slightly on the basis of whether an individual had a previously diagnosed psychiatric disorder.ConclusionsFactors associated with the initiation of an antipsychotic differ according to the presence of a psychiatric diagnosis. Given the long duration of antipsychotic use in this population, future research is needed to understand the appropriateness of antipsychotic initiation among adults with IDD and the safety implications of long-term use of these products.

Risk of hyperglycaemic crisis episode in diabetic patients with schizophrenia: A nationwide population-based cohort study

AimUnder-management of diabetes can lead to a hyperglycaemic episode (HCE), which could be further strengthened in the presence of schizophrenia and the use of antipsychotics. This study aims to investigate the risk of HCE in diabetic patients with schizophrenia. Additionally, the duration of antipsychotic use on the risk of HCE is examined. Materials and methodsA total of 13858 diabetic patients with schizophrenia and 55407 controls (without schizophrenia) matched by gender, age, index year, and Charlson Comorbidity Index score were included between 1999 and 2010 and followed to the end of 2013 using from the Taiwan National Health Insurance Research Database. During the follow-up period, participants who developed HCE were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (95% CI) of the HCE incidence rate between the two groups studied. ResultsDiabetic patients with schizophrenia were associated with an increased risk of HCE compared with unaffected controls after adjusted for baseline demographics and duration of antipsychotic use (4.73 versus 2.43 per 1,000 person-years, HR: 2.16, 95% CI: 1.85-2.51). Also, in diabetic patients with schizophrenia, a longer duration of antipsychotic use was associated with a lower risk of HCE after adjustment for the above-mentioned variables, suggesting a protective effect of antipsychotics against HCE during prolonged use. ConclusionThis study highlights the need to pay more attention to the risk of HCE in diabetic patients with schizophrenia and the importance of proper use of antipsychotics may reduce the risk of HCE.

Beta-cell Function and Metabolic Clearance Rate of Glucose in Patients with Major Mental Health Disorders on Antipsychotic Drug Treatment

BackgroundInsulin resistance and metabolic alteration continue to be essential features of major mental health disorders (MMHD) with poorly understood and multifaceted mechanisms. This study was carried out to provide information on insulin resistance, beta-cell function, metabolic clearance rate of glucose and their possible interplay with duration of antipsychotic use in patients with major mental health disorders. MethodologyPlasma levels of glucose and insulin were determined in 124 patients with MMHD after an overnight fast and at 30 and 120 min of standard Oral Glucose Tolerance Test. Thereafter, indices of insulin resistance, beta-cell function and estimated metabolic clearance rate of glucose (eMCR) were calculated appropriately. Statistical analysis was done using ANOVA, Kruskal Wallis, independent Student's t-test and Mann-Whitney U. P-values less than 0.05 were considered as statistically significant. ResultsMetabolic factors (fasting and postprandial glucose and insulin), indices of insulin sensitivity and β-cell function were not significantly different when patients with schizophrenia, bipolar and depression were compared with one another. Postprandial insulin level at 30 min (30 min PPI), estimated First and Second Phases of Insulin Release (eFPIR, eSPIR) were significantly lower in patients on atypical antipsychotic drugs [18.15 (3.57-40.35) μIU/ml), 617.63 (320.06-911.31) pmol/l, 180.30 (114.82–249.39) pmol/l] compared with patients on typical antipsychotic drugs [27.48 (13.33–47.68) μIU/ml, 767.69 (530.58-1198.35) pmol/l, 209.89 (154.01-310.97) pmol/l]. Furthermore, the mean waist circumference and body mass index were significantly higher in patients who have been on anti-psychotic drug for more than 10 years compared with patients with less than 5 years history of anti-psychotic use. eMCR of glucose progressively declined with increasing duration of antipsychotic use and it was significantly lower in patients who have been on antipsychotic drugs for more than 10 years [8.09 (5.90-9.44) ml.kg−1.min−1] compared with patients who have been on the drugs for less than 5 years [9.03 (7.47-10.04) ml.kg−1.min−1]. ConclusionPatients on atypical antipsychotics seem to have insulin secretion phases consistent with β-cell dysfunction. Also, chronicity of antipsychotic treatment predisposes patients with major mental health disorders to central adiposity and low metabolic clearance rate of glucose, a forerunner of glucose intolerance.

Tardive Dyskinesia Associated with Atypical Antipsychotics: Prevalence, Mechanisms and Management Strategies.

All antipsychotics, including the atypical antipsychotics (AAPs), may cause tardive dyskinesia (TD), a potentially irreversible movement disorder, the pathophysiology of which is currently unknown. The prevention and treatment of TD remain major challenges for clinicians. We conducted a PubMed search to review the prevalence and etiology of and management strategies for TD associated with AAPs. TD prevalence rates varied substantially between studies, with an estimated prevalence of around 20% in patients using AAPs. The risk of TD is lower with AAPs than with typical antipsychotics (TAPs) but remains a problem because AAPs are increasingly being prescribed. Important risk factors associated with TD include the duration of antipsychotic use, age, and ethnicity other than Caucasian. Theories about the etiology of TD include supersensitivity of the dopamine receptors and oxidative stress, but other neurotransmitters and factors are probably involved. Studies concerning the management of TD have considerable methodological limitations. Thus, recommendations for the management of TD are based on a few trials and clinical experience, and no general guidelines for the management of TD can be established. The best management strategy remains prevention. Caution is required when prescribing antipsychotics, and regular screening is needed for early detection of TD. Other strategies may include reducing the AAP dosage, switching to clozapine, or administering vesicular monoamine transporter (VMAT)-2 inhibitors. In severe cases, local injections of botulinum toxin or deep brain stimulation may be considered. More clinical trials in larger samples are needed to gather valid information on the effect of interventions targeting TD.

Physical Health Outcomes in Preschoolers with Prior Authorization for Antipsychotics.

To examine incidence of adverse health outcomes and associated factors among preschoolers (under age 6) who received antipsychotic treatment through the Florida Medicaid Prior Authorization (PA) program. Using Florida's PA registry linked to the state's Medicaid claims data, we ascertained incident outcomes during PA-approved antipsychotic use between April 2008 and September 2015 (7.5 years). Six outcomes associated with use of antipsychotics included: diabetes, obesity, hyperlipidemia, hyperprolactinemia, cardiovascular disease (CVD) (including hypertension, ventricular arrhythmia, and other CVDs), and extrapyramidal symptoms (EPS) (including dystonia, akathisia, parkinsonism, and tardive dyskinesia). Outcome-specific incidences were stratified by short-term (≤1 year) and long-term (>1-7 years) antipsychotic use. We used multivariate modified Poisson regressions to determine factors associated with these outcomes among preschoolers. The overall crude incidence during PA-approved antipsychotic use was highest for EPS and obesity (57 and 19 cases/1000 children-years, respectively). The rate of these two outcomes differed by duration of antipsychotic use. We observed a higher obesity (23.8 vs. 9.6, p < 0.001) and dystonia incidence (7.2 vs. 2.5, p < 0.05), but lower akathisia incidence (44.4 vs. 60.6, p < 0.05) among long-term antipsychotic users compared with short-term users. Five outcomes-ventricular arrhythmia, other cardiovascular side effects, hyperprolactinemia, parkinsonism, and tardive dyskinesia-occurred rarely (<2.0/1000 children-years). Preschoolers who were younger at baseline (≤2 years old vs. 4-5 years old) and Black (vs. White) were at a higher risk of EPS. Risk for EPS and obesity deserves clinical attention during antipsychotic treatment among preschoolers. Controlled studies that allow interpretation of these incidence rates in the context of background risk and that formally quantify the incremental risk associated with antipsychotic initiation during early childhood are needed.

Risk of Mortality Associated with Antipsychotic Monotherapy and Polypharmacy Among Community-Dwelling Persons with Alzheimer's Disease.

We aimed to analyze the risk of non-cancer mortality according to duration of antipsychotic use and to compare the risk associated with polypharmacy and monotherapy among community-dwellers with Alzheimer's disease (AD). The risk of mortality between most frequently used antipsychotic drugs was compared. Data from a nationwide register-based MEDALZ study that included all 70,718 community-dwellers newly diagnosed with AD during 2005-2011 in Finland was utilized. Death, excluding cancer as direct cause of death, was extracted from Causes of Death Register. Incident antipsychotic use was compared with time without antipsychotics with Cox proportional hazard models. Antipsychotic use was associated with an increased risk of mortality (adjusted hazard ratio [aHR] 1.61; 95% Confidence Interval [CI] 1.53-1.70). The absolute difference in mortality rate was 4.58 (95% CI 4.53-4.63) deaths per 100 person-years. The risk of mortality was increased from the first days of use and attenuated gradually but remained increased even after two years of use (aHR 1.30; 95% CI 1.16-1.46). Compared with nonuse, antipsychotic polypharmacy (aHR 2.88; 95% CI 2.38-3.49) was associated with an increased risk of mortality than monotherapy (aHR 1.57; 95% CI 1.49-1.66). Haloperidol was associated with higher risk of mortality (aHR 1.52; 95% CI 1.14-2.02) and quetiapine with lower risk (aHR 0.84; 95% CI 0.75-0.94) compared with risperidone. In conclusion, the findings support current treatment guidelines on having a high threshold for antipsychotic initiation among persons with AD. Antipsychotic polypharmacy and long-term use should be avoided and drug choice should be weighed against risk/benefit evidence.

Uzun süreli ve yatırılarak izlenen şizofreni hastalarında tardiv diskinezi

Objective: Tardive dyskinesia (TD) is a group of delayed-onset iatrogenic movement disorders caused by dopamine receptor-blocking agents. TD prevalence is estimated as 20-50% of all patients treated with neuroleptics. This study aimed to investigate the prevalence rate of TD in long-term hospitalized patients with schizophrenia. Method: We recorded age, gender, duration and type (first/second generation or mixed) of medication both at the time of interview and over preceding years. Dyskinesia was assessed by using the Abnormal Involuntary Movements Scale (AIMS). We also used the Simpson–Angus Scale for tardive parkinsonism. Akathisia was measured using the Barnes Akathisia Rating Scale (BARS). Results: Mean duration of the longest used antipsychotic was 206.63 months. Probable TD was found in 18 (22.5%) of patients. None of the patients had tardive akathisia. Relation between type of the longest used treatment and prevalence of TD was not statistically significant. Relationship between type of ongoing treatment and prevalence of TD was not determined statistically significant either. There was a statistically significant relationship between the mean age and TD. Discussion: Despite very long duration of antipsychotic use, 22.5% rate of prevalence is still lower than expected. This can be explained that these patients are under direct and close follow-up of healthcare providers and in hospital conditions, so that risky conditions can be intervened rapidly. Another noteworthy finding of our study is that there is no statistically significant difference betwen first and second generation antipsychotic use and TD prevalence.

Mortality Risk of Antipsychotic Dose and Duration in Nursing Home Residents with Chronic or Acute Indications.

To examine disease-specific associations between antipsychotic dose and duration and all-cause mortality. Retrospective cohort study. A 5% random sample of Medicare beneficiaries who had a Minimum Data Set 2.0 clinical assessment completed between 2007 and 2009. Three mutually exclusive cohorts of new antipsychotic users with evidence of severe mental illness (SMI, n=5,621); dementia with behavioral symptoms (dementia+behavior) without SMI (n=1,090); or delirium only without SMI or dementia+behavior (n=2,100) were identified. Dose and duration of therapy with antipsychotics were assessed monthly with a 6-month look-back. Dose was measured as modified standardized daily dose (mSDD), with a mSDD of 1 or less considered below or at recommended maximum geriatric dose. Duration was categorized as 30 or fewer, 31 to 60, 61 to 90, and 91 to 184days for SMI and dementia+behavior and 7 or fewer, 8 to 30, 31 to 90, and 91 to 184days for delirium. Complementary log-log models with mSDD and duration as time-dependent variables were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. In all three groups, new antipsychotic users with a mSDD of 1 or less had significantly lower mortality risk (HRSMI =0.77, 95% CI=0.67-0.88; HRdementia+behavior = 0.52, 95% CI=0.36-0.76; HRdelirium =0.61, 95% CI=0.44-0.85) than peers with a mSDD greater than 1. Individuals with longer duration of antipsychotic use (91-184days for SMI and delirium) had significantly lower mortality than those with a short duration of use (≤30days for SMI; ≤7days for delirium). The interaction between dose and duration was statistically significant in the SMI cohort (P<.001). Lower mortality was observed with within-recommended dose ranges for dementia+behavior, SMI, and delirium and with long duration of antipsychotic use for the latter two disease groups. Prescribers should monitor antipsychotic dosage throughout the course of antipsychotic treatment and customize dose and duration regimens to an individual's indications.

The use of antipsychotics among people treated with medications for dementia in residential aged care facilities.

Antipsychotic agents have limited efficacy for Behavioral and Psychological Symptoms of Dementia (BPSD) and there are concerns about their safety. Despite this, they are frequently used for the management of BPSD. This study aimed to assess the use of antipsychotics among people on anti-dementia medicines in Australian residential aged care facilities. Data were obtained from an individual patient unit dose packaging database covering 40 residential aged care facilities in New South Wales, Australia. Residents supplied an anti-dementia medicine between July 2008 and June 2013 were included. Prevalence of concurrent antipsychotic use was established. Incident antipsychotic users between January 2009 and December 2011 were identified. We examined initial antipsychotic dose, maximum titrated doses, type and duration of antipsychotic use, and compared use with Australian guidelines. There were 291 residents treated with anti-dementia medicines, 129 (44%) of whom received antipsychotics concomitantly with an anti-dementia medicine. Among the 59 incident antipsychotic users, risperidone (73%) was the most commonly used antipsychotic agent. Amongst the risperidone initiators, 43% of patients had initial doses greater than 0.5 mg/day and 6% of patients exceeded 2.0 mg/day for their maximum dose. 53% of concomitant users received daily treatment for greater than six months. Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.

Long-term use of antipsychotics among community-dwelling persons with Alzheimer׳s disease: A nationwide register-based study

Antipsychotics are recommended only for short-term treatment of severe behavioral and psychological symptoms of dementia. Our objective was to study the duration of antipsychotic use and factors associated with long-term use (365 days or over) among community-dwelling persons with Alzheimer׳s disease (AD) during a 7-year follow-up. This was a nationwide register-based cohort study including all community-dwelling residents in Finland diagnosed with AD in 2005 (n=7217). The follow-up for antipsychotic use started 3 years before the diagnosis of AD and we applied a 7-year washout period to ascertain truly incident antipsychotic use. Follow-up ended on institutionalization, death or at the end of study period (December 31, 2009). Duration of antipsychotic use was modeled from individual purchase histories recorded in the Finnish Prescription Register. During the 7-year follow-up, 34% (2287/6740) of persons initiated antipsychotic use. Median duration of the first antipsychotic use period was 219 (interquartile range 85–583) days. Of those who discontinued antipsychotic use (n=1303), 44% restarted use later. Among users with at least one year of follow-up time after initiating antipsychotic use, prevalence of long-term use was 57% (893/1563). Long-term use was associated with initiation of use after AD diagnosis and choice of antipsychotic. Duration of use was more likely to be shorter among haloperidol users and longer among quetiapine users compared with risperidone users. In conclusion, long-term use of antipsychotics is frequent among community-dwelling persons with AD. Duration of use is not in line with the guidelines recommending time-limited use of antipsychotics.

Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications.

The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP. A comprehensive literature search identified 28 articles that reported data on AP-specific weight or BMI change in FEP. We conducted a meta-analysis of short- and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs. Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo. Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

The Pharmacoepidemiology of Antipsychotic Medications for Canadian Children and Adolescents: 2005–2009

To describe the frequency and trends of use of antipsychotics in Canadian children and adolescents from 2005 to 2009. We performed analyses on the IMS Brogan databases on drug recommendation (prescribed drug) frequency, reasons for recommendations (therapeutic indication), and duration of use of antipsychotics, psychostimulants, and selective serotonin reuptake inhibitors (SSRIs) for Canadian children between 2005 and 2009. Changes in the number of and reasons for drug recommendations over the 5-year period are highlighted by using descriptive statistics. Antipsychotic drug recommendations by all specialists for children increased by 114% from 2005 to 2009. In contrast, psychostimulant and SSRI drug recommendations increased by 36% and 44%, respectively. The majority of antipsychotic drug recommendations were for second-generation antipsychotics (SGAs). Attention-deficit/hyperactivity disorder (ADHD) was the most common therapeutic indication associated with an SGA recommendation. Antipsychotic drug recommendations for children with ADHD more than tripled between 2005 and 2009. The average duration of antipsychotic use in children varied by drug and age group. For risperidone, median duration of use was 90 days in children aged 1-6, 180 days in children aged 7-12, and 200 days in children aged 13-18. The use of antipsychotics in Canadian children greatly increased from 2005 to 2009. Comparison of antipsychotic data with psychostimulant and SSRI data shows that there has been a disproportionate increase in antipsychotic use over this interval, despite the lack of approval for pediatric use by Health Canada. Postmarketing surveillance activities of antipsychotic use in children appear appropriate.

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

Objective(s)To characterize the longitudinal patterns of antipsychotic treatment and to investigate the relationship between antipsychotic treatment patterns and acute hospitalizations among adults with schizophrenia. We hypothesized that continuous antipsychotic treatment would be associated with fewer hospitalizations and shorter lengths of stay. MethodSeven years of retrospective Maryland Medicaid administrative data were used to examine inpatient medical encounters and outpatient psychotropic treatment in community-based settings from 1993 through 2000. The sample consisted of 1727 adults continuously enrolled in the Maryland Medicaid program from July 1992 through June 1994, and diagnosed with schizophrenia. The main outcome measures were a) any schizophrenia hospitalization; b) number of schizophrenia hospitalizations; and c) inpatient days associated with a primary diagnosis of schizophrenia. ResultsThe average duration of antipsychotic use was six months in any single year and four and one-half years across the entire study period. Compared to individuals with a more continuous pattern of antipsychotic treatment, individuals with moderate or light use had odds of hospitalization for schizophrenia that were 52 or 72% greater (95%CI: 30–75% greater, 49–100% greater respectively). Light users of antipsychotics have an average length of stay per hospitalization that is approximately 20% longer than the average for continuous users (95%CI: 2–39% longer). ConclusionsFindings emphasize the benefit of continuous antipsychotic treatment for individuals with schizophrenia.