Five-Year Cumulative Exposure to Antipsychotic Medication After First-Episode Psychosis and its Association With 19-Year Outcomes
Bergström, T., Taskila, J. J., Alakare, B., Köngäs-Saviaro, P., Miettunen, J., & Seikkula, J. (2020). Five-Year Cumulative Exposure to Antipsychotic Medication After First-Episode Psychosis and its Association With 19-Year Outcomes. Schizophrenia Bulletin Open, 1(1), Article sgaa050. https://doi.org/10.1093/schizbullopen/sgaa050
Published inSchizophrenia Bulletin Open
© The Author(s) 2020. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center
The long-term effectiveness of antipsychotic maintenance treatment after first-episode psychosis (FEP) is contested. In this real-world observational study, we examined how cumulative exposure to antipsychotics within the first 5 years from FEP was associated with the 19-year outcome. Finnish national registers were used to detect all patients who were hospitalized due to non-affective psychosis in the mid-1990s, and who were treatment naïve prior to the inclusion period (N = 1318). Generalized linear models with logit link function were used to estimate how cumulative exposure to antipsychotics within the first 5 years from onset was associated with mortality, work capability, and the use of psychiatric services at the end of the 19-year follow-up. To adjust for confounding by indication, the primary outcome analyses implemented stabilized inverse probability of treatment weighting using propensity scores. Persons with a higher cumulative exposure to antipsychotics within the first 5 years from FEP were more likely to still be receiving antipsychotics (adjusted odds ratio [OR] = 2.1; 95\\% CI: 1.5−2.8), psychiatric treatment (OR = 1.4; 95\\% CI: 1.1−1.7), and disability allowances (OR = 1.3; 95\\% CI: 1.01−1.6) at the end of the 19-year follow-up, as compared to low/zero-exposure. Higher cumulative exposure was also associated with higher mortality (OR = 1.5; 95\\% CI: 1.1–2.1). After adjustment for confounders, moderate and high cumulative exposure to antipsychotics within the first 5 years from FEP was consistently associated with a higher risk of adverse outcomes during the 19-year follow-up, as compared to low or zero exposure. Due to potential unmeasured confounding, controlled trials are needed. ...
PublisherOxford University Press (OUP)
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Additional information about fundingSupported in part by Finnish State Research Funding (VTR), granted by the Ministry of Social Affairs and Health, Finland. The funding source had no involvement in the design, collection, analysis, or interpretation of the date.
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