Use Of Typical Antipsychotics Research Articles

Antipsychotics-related hyperprolactinaemia among patients with schizophrenia in Maiduguri.

Hyperprolactinaemia among patients on antipsychotic medications is generally overlooked due to lack of outwardly visible symptoms, patient resistance to reporting because the symptoms are perceived as shameful, or to clinician's insufficient knowledge. The study aimed to evaluate the patterns and correlates of hyperprolactinemia among patients with schizophrenia on antipsychotic medications. The study was conducted in a psychiatric facility in Maiduguri, Northeastern Nigeria. A total of 209 patients with schizophrenia were evaluated through a cross-sectional design and assayed for serum prolactin with ELISA Kits. Frequencies and percentages were tabulated for categorical variables. Variables with significant associations with hyperprolactinaemia on chi-square (p < 0.05) were subjected to logistic regression analysis. The prevalence of hyperprolactinaemia was 45.9% in all patients on antipsychotic medication. The prevalence because of the use of typical and atypical antipsychotics was 51.5% and 25.0%, respectively. Hyperprolactinaemia was significantly associated with typical antipsychotics (β = 0314, p = 0.002), high overall drug dosage (β = 2.340, p = 0.003), high-dose typical antipsychotics (β = 3.228, p = 0.000), twice daily dosing frequency (β = 2.751, p = 0.001) and polypharmacy (β = 1.828, p = 0.0024). The findings support that patients on typical, high-dose antipsychotic medications and polypharmacy have a high prevalence of hyperprolactinaemia. As hyperprolactinaemia is often undetectable, screening and patient psycho-education on the significance of the signs and symptoms of hyperprolactinaemia is required for necessary clinical intervention. The study provides evidence for the rational use of antipsychotic medications in sub-Saharan Africa.

Antipsychotics and Risks of Cardiovascular and Cerebrovascular Diseases and Mortality in Dwelling Community Older Adults.

This study aims to investigate the effect of antipsychotic agents on cardiovascular and cerebrovascular diseases (CVD/CEV) and mortality risks in the older population living in a community. A cohort of 42,650 new users of antipsychotic agents was built using Quebec healthcare databases (1998-2011). The outcomes were CVD/CEV and mortality incidence in 5 years of follow-up in the total cohort, sub-cohort of patients with no schizophrenia/dementia, sub-cohort with schizophrenia, and sub-cohort with dementia. Comparisons were made between the new users who continued the treatment (adherent level ≥ 60%) vs. those ceasing treatment (adherence level < 60%) using inverse probability of treatment weighting and Cox models. Comparing high adherence vs. low levels, CVD/CEV risk was increased by 36% in the sub-cohort with schizophrenia for atypical antipsychotic users and by 25% in the sub-cohort with dementia for typical antipsychotic users. An increasing mortality risk of 2- to 3-fold was linked with the typical antipsychotic use in all cohorts except the sub-cohort with schizophrenia; in addition, mortality risk is linked with the use of high vs. low doses. Antipsychotics were not linked with CVD/CEV risk, except for atypical antipsychotics in patients with schizophrenia and typical antipsychotics in patients with dementia. The mortality risk was linked with the use of typical antipsychotics and the dose used.

Assessing the relationship between antipsychotic drug use and prolidase enzyme activity and oxidative stress in schizophrenia patients: a case-control study.

The relationship between proline, its association with oxidative stress, and its connection to schizophrenia is a subject that has not been sufficiently investigated. The aim of this study is to evaluate the possible effects of atypical and combined (typical and atypical) antipsychotic use on serum prolidase enzyme activity (SPEA) and serum oxidative stress parameters, and to assess the relationship between SPEA and oxidative stress in patients with schizophrenia. A total of 57 patients with schizophrenia, of which 34 were using atypical (AAPG) and 23 were using combined (typical and atypical) (CAPG) antipsychotic therapy, and 28 healthy volunteers (control group) were included in this case-control study. SPEA levels of AAPG and CAPG were significantly lower than that of control group ( P = 0.003). The oxidative stress index (OSI) value of AAPG was significantly higher than the other two groups ( P = 0.001). SPEA (<1860 U/l) and OSI (≥0.54) could discriminate schizophrenia patients with antipsychotic therapy from control groups ( P = 0.001 and P = 0.007, respectively). Lower SPEA levels were associated with antipsychotic use ( P = 0.007). The SPEA values of patients with schizophrenia on antipsychotics were significantly lower compared to controls. OSI values were significantly higher in atypical antipsychotic recipients compared to those on combined antipsychotics and healthy controls.

Effect of Olanzapine and Risperidone on prolactin level in schizophrenic patients

Hyperprolactinemia is a well-established adverse effect associated with the use of typical and atypical antipsychotics. Hyperprolactinemia is associated with both acute and chronic clinical consequences in men and women. Increased prolactin levels received little attention and were rarely monitored. Therefore, the primary objective of this study is to investigate the effects of two atypical antipsychotics (olanzapine and risperidone) on prolactin level in schizophrenic patients. For this purpose, a therapeutic clinical trial was done. We prospectively recruited 28 schizophrenic patients attended to Social and Psychiatric Service Centre in Mosul city. All patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for schizophrenia. They were randomized to receive monotherapy with either olanzapine in a dose 5-20 mg or risperidone in a dose 4-12 mg for 8 weeks (two groups). Also 22 apparently healthy subjects with approximately age and sex matching to the patients groups without previous history of schizophrenia or any other psychiatric disorders were taken as a control group. This study shows that, at baseline, there were no significant differences between the three studied groups in term of prolactin level and, after treatment with these drugs for 8 weeks, both drugs caused a significant increase in the prolactin level compared to baseline levels and that risperidone causes significantly greater increase in the levels of prolactin than olanzapine

Overview of prolactin levels in patients with schizophrenia during antipsychotic therapy at HB. Saanin Mental Hospital Padang, Indonesia

Background: Schizophrenia, which affects about 0.85% of people worldwide, is the most common illness among psychotic disorders. Antipsychotic drugs have been a mainstay of schizophrenia treatment. Antipsychotics are now the most typical factor causing increased prolactin levels (hyperprolactinemia). This research aimed to determine the overview of prolactin levels in patients with schizophrenia that receive antipsychotic therapy at HB. Saanin Mental Hospital Padang. Methods: This descriptive research included 50 patients with schizophrenia at HB. Saanin Mental Hospital Padang in July-December 2020. It was conducted using the ELISA test method to analyze prolactin levels. Data were analyzed using SPSS version 20.0 for Windows. Results: From a total sample of 50 patients, the research subject characteristics were as follows, the mean age of the research subjects was 39.48±12.53 years old, most were male (68.0%), and the most used antipsychotics given were second-generation antipsychotics (Atypical) (64%). The prolactin level among the research subjects was 30.20 ng/mL (CI 95% 25.18-36.31). It indicates that the average prolactin level in the research subjects is higher than the normal prolactin level, which is 5-25 ng/mL. The research results showed that females have a significant higher average prolactin level than males (p&lt;0.05). However, the use of typical, atypical, and combination antipsychotics do not show significant differences between groups (p&gt;0.05). Conclusion: Patients with schizophrenia at HB. Saanin Mental Hospital Padang, who became the research respondents and consumed antipsychotics, has higher prolactin levels than average.

GAMBARAN KEJADIAN EKSTRAPIRAMIDAL SINDROM PADA PASIEN TERAPI ANTIPSIKOTIK TIPIKAL DI RUMAH SAKIT JIWA ACEH

The use of antipsychotics in schizophrenic patients often causes side effects in the form of Extra Pyramidal Syndrome (EPS), namely the presence of uncontrolled muscle movement disorders such as seizures, shaking and so on. The incidence of EPS is more common with the use of typical antipsychotics than atypicals. This study aims to see the incidence of EPS in inpatients with schizophrenia at the Aceh Mental Hospital located in Banda Aceh in 2020. The population in this study were all inpatients who were given typical antipsychotics. While the research sample was 399 samples collected from medical record data of inpatients in 2020, so the study was retrospective with a cross sectional approach. Data collected in the form of patient identity (gender, age), drug therapy (typical antipsychotics) and the incidence of EPS. The results showed that schizophrenic patients who received typical antipsychotic therapy who were hospitalized at the Aceh mental hospital in 2020, were 324 men (81.2%) and 75 women (18.8%), with the highest age range being at 36-45 years amounting to 202 people (50.6%). Typical antipsychotic therapy used in the form of combination of typical-typical and typical-atypical drugs, namely clozapine-trifluperazine (40.6%), chlorpromazine-risperidone (20.3%), haloperidol-chlorpromazine-trifluperazine (16%), haloperidolchlorpromazine (7%), and haloperidol-trifluperazine (5%). The incidence of EPS that occurred was 113 people (28.3%), with the highest number of EPS occurring from the administration of haloperidol-chlorpromazine-trifluperazine combination antipsychotic therapy, which was 61 people (15.3%).

Successful Treatment with Lurasidone of First-Episode Psychosis in Down Syndrome: Case Report and Literature Review

IntroductionCo-morbid psychiatric disorders are common in Down syndrome (DS). Evidence is limited for pharmacotherapy, specifically antipsychotics, for psychiatric co-morbidity in DS.ObjectivesTo describe a case of a patient with DS who developed a first-episode psychosis (FEP) and who responded to lurasidone in monotherapy and to review recent literature on the treatment of psychosis in patients with DS.Methods(1) Case report: FEP in DS patient treated with lurasidone 37 mg/day. (2) Narrative review on the treatment of psychosis in DS patients through PubMed database (1990-2020). Key terms: “psychosis”, “Down Syndrome”, “pharmacological treatment”, “antipsychotic drugs”.ResultsA 21-year-old woman with DS, without psychiatric history, presenting with behavioural anomalies, aggressiveness, soliloquies, and unmotivated laughs was referred to our outpatient clinic by her general practitioner. Symptoms began one year prior and progressively worsened, impairing her daily functionality. Previous blood workup was normal. She was diagnosed with FEP and began treatment with lurasidone 37 mg. At 4-week follow-up, she showed total remission of the psychotic symptoms, had no tolerability complaints, and returned to baseline functionality levels. Discussion: No reports of lurasidone use in psychosis in DS have been published. To treat psychotic symptoms in DS, most literature reports describe the use of typical antipsychotics, which are usually effective, but often poorly tolerated; atypical antipsychotics such as risperidone and aripiprazole have also been used.ConclusionsLurasidone may be a useful option in patients with FEP in DS. Further research is warranted on treatment of psychosis in this population.DisclosureNo significant relationships.

Typical antipsychotics is associated with increased risk of severe exacerbation in asthma patients: a nationwide population-based cohort study

BackgroundSevere asthma exacerbation reduces patients’ quality of life, results in visits to the emergency department (ED) and hospitalization, and incurs additional medical costs. Antipsychotics block receptors with bronchodilation function; however, the association between antipsychotic use and severe asthma exacerbation is unknown. This study aimed to investigate the effects of antipsychotics on asthma-related ED visits and hospitalizations.MethodsA case-crossover design was used in this study. Using the 2003–2017 Taiwan National Health Insurance Reimbursement Database, we established a cohort of 18,657 adults with asthma exacerbation leading to ED visits or hospitalization. Univariate and multivariate conditional logistic regressions were conducted to explore the association between antipsychotic use and severe asthma exacerbation. Subgroup analyses of different classes, doses, receptor functions of antipsychotics, different psychiatric disease, and sensitivity analyses of excluding patients with schizophrenia were also performed.ResultsAntipsychotic use was associated with a higher risk of severe asthma exacerbation (adjusted odds ratio [OR]: 1.27; 95% confidence interval [CI] 1.05–1.54; P = 0.013) compared with no use of antipsychotics. The use of typical antipsychotics increased the risk of severe asthma exacerbation (adjusted OR: 1.40, 95% CI 1.10–1.79, P = 0.007), whereas the use of atypical antipsychotics did not. These results did not change after the exclusion of patients with schizophrenia. There was a dose-dependent effect of antipsychotics (trend test, P = 0.025). Antipsychotics that block the M2 muscarinic or D2 dopaminergic receptors were associated with an increased risk of severe asthma exacerbation (adjusted OR: 1.39, 95% CI 1.10–1.76, P = 0.007 and adjusted OR: 1.33, 95% CI 1.08–1.63, P = 0.008, respectively). However, use of antipsychotics did not increase risk of severe asthma exacerbation in patients with psychiatric disorder.ConclusionsThe use of typical antipsychotics is associated with a dose-dependent increased risk of severe asthma exacerbation, especially for patients without psychiatric disorders. Further research on the impact of typical antipsychotics on asthma exacerbation is warranted.

Assessment and management of agitation in consultation-liaison psychiatry

Assessment and management of agitation in consultation-liaison psychiatry

Modern possibilities of anti-relapse therapy of schizophrenia (experience with the use of aripiprazole)

The review is devoted to the actual problem of anti-relapse therapy for schizophrenia. The features of the use, efficiency, tolerability and safety of typical and atypical antipsychotics are discussed. The possibilities of using atypical antipsychotics of the third generation - partial dopamine receptor agonists - on the aripiprazole model are considered. According to numerous studies, aripiprazole, due to its unique pharmacological profile and combination of clinical factors, is the drug of first choice for anti-relapse supportive therapy of schizophrenia.

Effect of medication on risk of traumatic brain injury in patients with bipolar disorder: A nationwide population-based cohort study.

Increased traumatic brain injury (TBI) risk was found in patients with bipolar disorder (BPD). Whether the medications for BPD and dosage moderate the risk of TBI is not clear. This study aimed to determine whether an association exists between BPD and TBI and whether the prescription of psychotropics moderates TBI risk. A total of 5606 individuals who had received diagnoses of BPD between January 1, 1997 and December 31, 2013 and 56,060 matched controls without BPD were identified from Taiwan's National Health Insurance Research Database. Cases and controls were followed until the date of TBI diagnosis. BPD was associated with a high risk of TBI (adjusted hazard ratio (aHR): 1.85; 95% CI: 1.62-2.11). Patients with BPD, with or without a history of psychiatric hospitalization, had increased risks of TBI (aHR: 1.94, 95% CI: 1.57-2.4 and aHR: 1.82, 95% CI: 1.55-2.1, respectively). The prescription of typical antipsychotics (0 < defined daily dose (DDD) < 28: hazard ratio (HR) = 1.52, 95% CI: 1.19-1.94; ⩾28 DDD: HR = 1.54, 95% CI: 1.15-2.06) and tricyclic antidepressants (TCAs) (0 < DDD < 28: HR = 1.73, 95% CI: 1.26-2.39; ⩾28 DDD: HR = 1.52, 95% CI: 1.02-2.25) was associated with higher TBI risk. Patients receiving higher doses of benzodiazepines (BZDs) (cumulative dose ⩾28 DDD) had a higher TBI risk (HR = 1.53, 95% CI: 1.13-2.06). Patients with BPD have a higher risk of TBI. The use of typical antipsychotics, TCAs, or high-dose BZDs increases the risk of TBI in BPD.

Occurrence of metabolic diseases associated with antipsychotic use among Korean patients with schizophrenia.

Metabolic side effects of antipsychotics significantly affect adherence to medication. We aimed to identify factors associated with the occurrence of metabolic diseases among Korean patients with schizophrenia (SCZ) from the national health insurance system database. We evaluated the frequency of antidiabetic and antihyperlipidemic use after diagnosis of SCZ according to typical or atypical antipsychotic use. Among the 43,800 patients diagnosed with SCZ between 2008 and 2012, 29,591 patients who had no metabolic diseases before the diagnosis were included in the analysis to investigate the occurrence of metabolic diseases associated with antipsychotic use. The associations between the development of metabolic diseases and patient characteristics were evaluated using logistic regression analysis. Use of both typical and atypical antipsychotics (multivariate-adjusted odds ratio (OR), 1.2513; 95% confidence interval (CI), 1.0953-1.4294) was associated with higher incidence of metabolic diseases than without their use. Among the atypical antipsychotics, use of clozapine (multivariate-adjusted OR, 1.1959; 95% CI, 1.0086-1.4179) and quetiapine (multivariate-adjusted OR, 1.1284; 95% CI, 1.0446-1.2189) showed higher incidence of metabolic diseases compared to that without their use. Among the patients using ≥1 type of antidiabetic or antihyperlipidemic agents within 6years after diagnosis of SCZ, the proportion of patients using only atypical antipsychotics was greater than those using only typical antipsychotics. The use of both typical and atypical antipsychotics, and clozapine and quetiapine treatment, may be associated with the occurrence of metabolic diseases in patients with SCZ. Additional prospective studies with accurate dosage information are needed to validate our findings.

Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries.

Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries.

Diabetes mellitus asociada al uso crónico de antipsicóticos atípicos

Los agentes antipsicóticos son considerados como el principal tratamiento farmacológico para el manejo de mantenimiento y el tratamiento de casos agudos de la esquizofrenia y otros trastornos mentales. Estos medicamentos están clasificados en dos grupos: los antipsicóticos de primera generación o antipsicóticos típicos (AT) y los antipsicóticos de segunda generación o antipsicóticos atípicos (AA). En relación con el uso de los antipsicóticos típicos (AT), se han descrito importantes efectos adversos, sobre todo síntomas extrapiramidales (EPS), lo cual ha relegado su uso y fomenta el mayor empleo en la práctica clínica de los antipsicóticos atípicos (AA) gracias a la adecuada efectividad clínica demostrada hasta el momento. Sin embargo, estos medicamentos están asociados con diferentes alteraciones metabólicas, entre las cuales se encuentra un mayor riesgo de diabetes; para lo cual se han propuesto varios mecanismos etiopatogénicos. En esta revisión narrativa, se presenta un resumen actualizado de la literatura de los últimos 5 años sobre el uso de antipsicóticos atípicos y la diabetes mellitus tipo 2, haciendo énfasis en las diferentes hipótesis reportadas hasta el momento que involucran el aumento de peso y diferentes efectos mediados por hormonas, receptores de neurotransmisores y neuropéptidos que impactan en la génesis de los estados hiperglucémicos y de insulinorresistencia.

Antipsychotic Medication in Schizophrenic Patients is Associated with Higher Risks of Developing Bone Fractures and Refractures

ObjectiveThe relationship of antipsychotics and the risk of refracture in treated patients is unclear. The aim of this study is to evaluate the association between prolonged antipsychotic and the incidences of bone fractures and refractures in schizophrenia.MethodsThis is a retrospective nested case-control study using Taiwan National Health Insurance Research Database recorded from 2000 to 2005, with cases followed up to end of 2011. Total of 7,842 schizophrenic patients, 3,955 had developed bone fractures were compared with 3,887 control subjects matched in age, sex, and index date. Antipsychotic drug exposure was classified based on the drug type and medication duration. Conditional logistic regression analyses were performed. Odds ratio (OR) and confidence interval (CI) were calculated.ResultsWe found (after adjustments) higher risks of developing fractures under continued use of typical (OR = 1.70; 95% CI, 1.51−1.91) or atypical antipsychotics (OR = 1.43; 95% CI, 1.28−1.60) were found. Additionally, continued use typical (OR = 1.84; 95% CI, 1.35−2.50) or atypical antipsychotics (OR = 1.44; 95% CI, 1.06−1.95) was positively associated with refracture risks. Moreover, refractures were associated with continuous use of chlorpromazine (one typical antipsychotics, OR = 2.45; 95% CI, 1.14−5.25), and risperidone (OR = 1.48; 95% CI, 1.01−2.16) or zotepine (OR = 2.15; 95% CI, 1.06−4.36) (two atypical antipsychotics).ConclusionHigher risks of bone fracture and refracture were found in schizophrenia under prolonged medication with typical or atypical antipsychotics. We therefore recommend that clinicians should pay more attention on bone density monitoring for patients using long-term antipsychotics.

Relationship between administrative characteristics of long-term care institutions and use of antipsychotics and anxiolytics in residents with cognitive impairment.

To identify the facility characteristics that are associated with prescribing practices of typical and atypical antipsychotics, and anxiolytics in residents with cognitive impairment in long-term care (LTC) institutions. A cross-sectional analysis of a country-representative sample of 23 LTC institutions in Poland was conducted in 2015-2016. Trained staff from each facility used the InterRAI-LTCF tool and drug dispensary cards on the day of resident's assessment to collect data on medication use from 455 residents with cognitive impairment. We used the anatomical therapeutic chemical classification and a multiple correspondence analysis. We identified facility characteristics associated with higher rate of prescribing of: typical antipsychotics (nursing home, private ownership status, higher staff/bed ratio of physicians and nurses, and lower as refers to care assistants); atypical antipsychotics (residential home, public ownership status, higher staff/bed ratio of care assistants, and lower as refers to physicians); and anxiolytics (residential home, facilities of small size, public ownership status, higher staff/bed ratio of care assistants, lower of nurses and physicians). In the facilities where less residents received typical antipsychotics, anxiolytics were prescribed more often, and vice versa (rho = -0.442; p = 0.035). This study showed a considerable variation in the use of typical and atypical antipsychotics, and anxiolytics between nursing and residential homes, which was associated with their organization (type, size, ownership status, and employment rate). We found a negative correlation between prescribing typical antipsychotics and anxiolytics, which made us aware that these medications may be used interchangeably in LTC facilities, despite the fact that both should be avoided.

Electroconvulsive Therapy as a Corrector for Certain Side Effects of Antipsychotic Therapy

The discovery of the first typical antipsychotics in the 1950s had revolutionized the treatment of many severe mental illnesses. This discovery opened the door for radical humanization and deinstitutionalization of the whole psychiatry. It also served as an impetus for the emergence of a new science, called psychopharmacology. This signaled the beginning of an era of widespread use of psychopharmacotherapy in psychiatry. However, the use of typical antipsychotics has been associated with many side effects, including severe ones, such as severe extrapyramidal syndrome, neuroleptic-induced deficit syndrome, cognitive impairment, and neuroleptic malignant syndrome. This necessitated the development of methods for correction or treatment of such side effects. Over the past decades, a number of new antipsychotics have been synthesised and approved for clinical use. Those new drugs are considered to belong to the group of so-called «atypical antipsychotics». This group, as a whole, has an improved tolerance and safety profile compared to older, conventional antipsychotics. In particular, these new drugs less often cause exactly the aforementioned side effects. Nevertheless, the problem of antipsychotic side effects and their correction is still far from being resolved. Some patients experiencing certain side effects from antipsychotic therapy do not get adequate relief from the standard pharmacological correction of those side effects. This fact stimulated our interest in the study of the possibilities of using electroconvulsive therapy as an alternative or adjuvant method for the correction of some side effects that can arise during antipsychotic therapy. In this article, we thoroughly discuss the existing evidence base regarding the effectiveness and safety of the use of electroconvulsive therapy as a corrector for certain side effects that can occur during antipsychotic therapy.

Atypical Antipsychotics in the Treatment of Substance-related Psychotic Disorders

In recent years, substance-related disorders have become an important public health problem due to the effects of substance use on the nervous system later in life periods. Substance-related disorders are basically divided into two categories; substance use disorders and substance-induced disorders. Substance-related disorders consist of substance intoxication, substance withdrawal and other substance-induced disorders such as substance-induced psychotic disorders. The possibility of conversion of substance use disorders to chronic psychotic disorders such as schizophrenia, bipolar disease reveals the importance of its diagnosis and treatment. In related cases, it is important to make distinction between the primer psychotic disorder and substance related disorder for correct diagnosis and effective treatment. Current treatment options for psychotic disorders caused by the substance include the use of typical (classic) and atypical antipsychotics. Nowadays, atypical antipsychotics are the primary drug of choice in the treatment of substance-induced psychotic disorders, not only because of their positive impacts on psychotic symptoms but also because of their reducing effect on substance craving and seeking and fewer extrapyramidal side effects compared to typical antipsychotics. This review aims to explain the pathogenesis of substance-related psychotic disorders and to discuss the atypical antipsychotics used in the treatment within the framework of current literature.&nbsp;

Antipsychotic drug use in pregnancy: A multinational study from ten countries

AimTo compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across four continents. MethodsIndividually linked health data in Denmark (2000−2012), Finland (2005–2014), Iceland (2004–2017), Norway (2005–2015), Sweden (2006–2015), Germany (2006–2015), Australia (New South Wales, 2004–2012), Hong Kong (2001–2015), UK (2006–2016), and the US (Medicaid, 2000–2013, and IBM MarketScan, 2012–2015) were used. Using a uniformed approach, we estimated the prevalence of antipsychotic use as the proportion of pregnancies where a woman filled at least one antipsychotic prescription within three months before pregnancy until birth. For the Nordic countries, data were meta-analyzed to investigate maternal characteristics associated with the use of antipsychotics. ResultsWe included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas atypical antipsychotic use was highest in the US Medicaid (1.5%). Atypical antipsychotic use increased over time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries, prochlorperazine was the most commonly used typical antipsychotic and quetiapine the most commonly used atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ≥4 in the Nordic countries. ConclusionAntipsychotic use during pregnancy varied considerably between populations, partly explained by varying use of the typical antipsychotic prochlorperazine, which is often used for nausea and vomiting in early pregnancy. Increasing usage of atypical antipsychotics among pregnant women reflects the pattern that was previously reported for the general population.

Atypical antipsychotics not associated with hospital deaths, except in elderly

A retrospective cohort study of hospitalized adults has reported that use of atypical antipsychotics was associated with lower risk of mortality or cardiopulmonary arrest than use of typical antipsychotics. Researchers did identify an increased risk of death or cardiopulmonary arrest in atypical antipsychotic users over age 65, however, and they urged caution regarding use of atypicals in any age group in the hospital setting. Study results were published online Nov. 19 in the Journal of the American Geriatrics Society.