The association of antipsychotic postponement with 5-year outcomes of adolescent first-episode psychosis
Bergström, T., & Gauffin, T. (2023). The association of antipsychotic postponement with 5-year outcomes of adolescent first-episode psychosis. Schizophrenia Bulletin Open, 4(1), Article sgad032. https://doi.org/10.1093/schizbullopen/sgad032
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Schizophrenia Bulletin OpenDate
2023Copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center
Background and Hypothesis
Based on the need-adapted approach, delaying antipsychotics could help identify first-episode psychosis adolescents who might not require them. However, some individuals might need antipsychotics, and postponing could harm their prognosis. This nationwide register-based follow-up aimed to test these two hypotheses.
Study Design
All adolescents aged 13-20 with a psychotic disorder (ICD-10 codes: F20-F29) in Finland between 2003-2013 were identified (n=6,354) from national registers. For each case, a fixed 1825-day follow-up period was established from the onset of psychosis or until death. The outcome was considered "good" if adolescents did not die and had not received psychiatric treatment and/or disability allowances during the final year of follow-up. Testing the first hypothesis involved all antipsychotic treatment-naïve adolescents with first-episode psychosis (n=3714). The second hypothesis was tested with a sub-sample of only those who had received antipsychotics during follow-up (n=3258). To account for baseline confounders, hypotheses were tested via a stabilized inverse probability of treatment weighted generalized linear models with logit link function.
Study Results
Immediate antipsychotic treatment after the onset of psychosis was associated with poor five-year outcome (adjusted odds ratio [aOR]: 1.8, 95% CI: 1.6-2.1). There was no statistically significant association between antipsychotic postponement and treatment outcome in those who eventually received antipsychotic treatment (aOR: 1.02, 95%CI: 0.7-1.2, p: 0.8), thus not providing support for second hypothesis.
Conclusions
There is a significant subgroup of adolescent with psychosis who do not require immediate antipsychotic treatment. A more robust design is needed to evaluate the causality of the observed association.
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Publisher
Oxford University PressConference
4, Issue 1, January 2023,ISSN Search the Publication Forum
2632-7899Keywords
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https://converis.jyu.fi/converis/portal/detail/Publication/194448163
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Additional information about funding
This work was supported by Research State Funding (VTR) granted by the Ministry of Health and Welfare, Finland.License
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