Long-term use of antipsychotics by patients with schizophrenia does not increase the risk of hospitalization for comorbid conditions such as cardiovascular disease—and is actually associated with substantially decreased mortality, according to a cohort study published in World Psychiatry.
Researchers investigated the rumored, yet unsubstantiated, harms of long-term antipsychotic use by tracking every patient who received inpatient care for schizophrenia between 1972 and 2014 in Finland. Specifically, they looked at hospitalizations and deaths during periods of antipsychotic use, compared with periods of no antipsychotic use, for each individual patient.
“It’s difficult to make comparisons between people on permanent medication and those who aren’t, as these groups differ in many ways,” said Heidi Taipale, PhD, assistant professor in the department of clinical neuroscience at Karolinska Institute in Sweden.
“One common method of dealing with this has been to try to take account of such differences when making comparisons. However, we chose another method, in which each person was their own control, making it possible for us to make individual comparisons of hospitalization during periods of antipsychotic medication and periods of no treatment.”
Among the study’s population of 62,250 patients, the median follow-up time was 14.1 years.
While an individual’s risk of hospitalization for a somatic disease and hospitalization for a cardiovascular disease did not differ during periods of antipsychotic use compared with periods without antipsychotic exposure, the study revealed a notable difference in mortality. Specifically, the cumulative mortality rate during periods of no antipsychotic use was 46%, compared with 26% during periods of antipsychotic use. Periods of clozapine use, notably, were associated with a cumulative mortality rate of 15.6%.
In addition to all-cause mortality, antipsychotic use was linked with lower risk of cardiovascular mortality as well as suicide mortality, according to the study.
“Antipsychotics get something of a bad press, which can make it difficult to reach out to the patient group with information on how important they are,” said researcher Jari Tiihonen, MD, PhD, professor of psychiatry at the department of clinical neuroscience, Karolinska Institute.
“Building trust and understanding towards the efficacy and safety of antipsychotic drugs is important, and we hope that this study can contribute to this end.”
Taipale H, Tanskanen A, Mehtälä J, Vattulainen P, Correll CU, Tiihonen J. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry. 2020;19(1):61-68.