The introduction of second-generation antipsychotic drugs during the 1990s is widely believed to have adversely affected mortality of patients with schizophrenia. Our aim was to establish the long-term contribution of antipsychotic drugs to mortality in such patients.
Nationwide registers in Finland were used to compare the cause-specific mortality in 66 881 patients versus the total population (5.2 million) between 1996, and 2006, and to link these data with the use of antipsychotic drugs. We measured the all-cause mortality of patients with schizophrenia in outpatient care during current and cumulative exposure to any antipsychotic drug versus no use of these drugs, and exposure to the six most frequently used antipsychotic drugs compared with perphenazine use.
Although the proportional use of second-generation antipsychotic drugs rose from 13% to 64% during follow-up, the gap in life expectancy between patients with schizophrenia and the general population did not widen between 1996 (25 years), and 2006 (22.5 years). Compared with current use of perphenazine, the highest risk for overall mortality was recorded for quetiapine (adjusted hazard ratio [HR] 1.41, 95% CI 1.09-1.82), and the lowest risk for clozapine (0.74, 0.60-0.91; p=0.0045 for the difference between clozapine vs perphenazine, and p
Comment In: Lancet. 2009 Nov 7;374(9701):1591; author reply 1592-319897117
Comment In: Lancet. 2009 Nov 7;374(9701):1591; author reply 1592-319897118
Comment In: Lancet. 2009 Aug 22;374(9690):590-219595448
Comment In: Lancet. 2009 Nov 7;374(9701):1592; author reply 1592-319897121
Comment In: Lancet. 2009 Nov 7;374(9701):1592; author reply 1592-319897120
Eleven cases of acetazolamide-associated aplastic anaemia were reported in Sweden during a 17-year period. There were six women and five men with a median age of 71 years (range 63-85 years). The median dose of acetazolamide was 500 mg, and the median duration of treatment was 3 months (range 2-71 months). Ten of the eleven patients died, all within 8 weeks after detection of their aplastic anaemia. The relative risk of developing aplastic anaemia when taking acetazolamide was 13.3 (95% confidence limits (CL); 6.8-25.3). The estimated incidence of reported acetazolamide-associated aplastic anaemia is approximately one in 18,000 patient years. The results strongly indicate that acetazolamide treatment is associated with a substantial increase in the risk of developing aplastic anaemia.
A random sample of claimants under Manitoba's Pharmacare plan provided information on the drugs prescribed for those individuals who spent more than $50 for drugs in 1978. More women than men were represented among the 412 claimants aged 50 to 64 (58% females), and more drugs were prescribed for women than men (8.38 +/- 3.4 vs. 7.17 +/- .33, mean +/- S.E.M., p less than 0.02). For the 403 claimants aged 65 and older, the sex distribution matched that of the general population (55%), and the difference in number of drugs prescribed was not statistically significant (8.49 +/- .36 vs 7.98 +/- .35). For the claimants aged 65 and older, the five most heavily prescribed drug categories were thiazide-type diuretics (prescribed for 51.6% of older claimants in 1978), benzodiazepines (40.0%), salicylates (26.8%), digoxin (22.6%) and codeine (20.8%). There were few differences in prescription frequencies between younger and older claimants, and these data indicate that drugs prescribed for heavy drug users do not change markedly as a function of age.
According to official Swedish epidemiological figures, during 1996 the number of abortions increased for the first time in the 1990s, breaking a declining trend, especially among women under 24 years of age. In several European countries a similar increase was reported. The number of induced abortions declined by 16.1% during 1990-95, whereas it increased by 2.3% in 1996 compared to the previous year. The corresponding increase was 4.1% for teenagers and 2.5% for women in the 20-24 age group. In Norway, a 7.2% increase was reported in the first half of 1996 compared to the first half of 1995, although there, too, there had been a declining trend during the 1990s. Preliminary figures from Denmark indicate an increase of abortions to 18,022 for 1996 vs. 17,720 for 1995. Similarly, in Great Britain, in the first half of 1996, the figure increased by 10% compared with the same period in 1995. More than 90% of women in Sweden use or have used oral contraceptives (OCs); about 50% of women up to age 24 use them, and for women up to age 29 OCs also continue to be the most frequently used contraceptive. In October 1995, the World Health Organization published an extensive epidemiological study, which showed that low-dose OCs containing third-generation gestagens pose double the risk of deep venous thrombosis compared to low-dose OCs containing second-generation gestagens. Immediately after this alarming report the trend of declining abortions stopped and the users of OCs dropped from 440,000 before the report to 370,000 in 1996 in Sweden.
The antibiotic consumption in Sweden was evaluated during the period 1975 to 1987. Consumption was measured in terms of defined daily doses (DDDs), that is, the normally prescribed daily adult doses. During the study period the total consumption varied between 49 and 51 million DDD, indicating a considerable over-use of antibiotics in Sweden. In the various groups of antibiotics, considerable fluctuations were seen. The cephalosporin use increased from 477000 DDDs 1975 to 1795000 DDDs in 1987, which can be explained by an increased use of cefaclor for treatment of respiratory tract infections and by the fact that cefuroxime is the dominant injectable antibiotic in Sweden. Markedly increased usage during the study period was also seen for erythromycin and penicillinase resistant penicillins. There were no obvious medical reasons for those increases. Among the folate inhibitors, sulphonamide usage has been almost completely abandoned during the period and the sulphonamides have been replaced by pivmecillinam, trimethoprim and, lately, norfloxacin for the treatment of urinary tract infections. Reduced usage was also seen for sulphonamide/trimethoprim combinations, probably due to an increased awareness of the risk for side effects to these antibiotics. During the entire period the use of tetracyclines, and especially doxycycline, was extensive--almost 10 million DDDs in 1987. The reason for that remains unclear but there are reasons to assume that these antibiotics are prescribed too frequently.
An educational programme on the use of antibiotics for respiratory tract infections (RTIs) in primary care, initiated among district physicians at the Community Health Centre of Höör, Sweden in 1985, resulted in an overall reduction in prescriptions for antibiotics, particularly broad-spectrum antibiotics. The aim of the present study was to evaluate the long-term effects of the programme on antibiotic prescription patterns at the centre. Since 1985, computerized records have been kept of every consultation at the centre, including details of the attending physician, the patient, diagnosis and type of antibiotic prescribed. Moreover, during a 3-month period in 1991, each pharmacy in the region recorded details of all prescriptions for antibiotics dispensed. Estimated immediately after the programme, the proportion of RTI patients prescribed antibiotics had fallen to 44%, a figure virtually unchanged 5 years later. During the subsequent five-year period, antibiotics dispensed at the pharmacy in Höör were further reduced from 14.1 to 13.2 defined daily doses 1000 inhabitants-1 day-1. As compared with district physicians at other community health centres in the region, those at Höör prescribed more penicillin V (80% of all antibiotic prescriptions) and less broad-spectrum antibiotics. The educational programme, combined with an active interest among district physicians at Höör in current research into antibiotic usage, has thus wrought enduring changes in the pattern of antibiotic prescription. A probable contributory factor was the district physicians' awareness that the computerized registration of diagnosis and treatment enables prescription patterns to be audited at an individual level.
The use of monoamine oxidase inhibitors (MAOIs) in the province of Saskatchewan was compared for two years, 1978 and 1986, using the Saskatchewan Prescription Drug Plan data base. The percentage of the adult population receiving an MAOI decreased from 0.17% in 1978 to 0.07% in 1986. The use of both tricyclic antidepressants and the new generation antidepressants increased during the same period. Physicians appear to have selectively avoided using MAOIs for the elderly. Physicians who are not psychiatrists showed the greatest reduction in their use of the MAOIs. The data indicate an increasing reluctance to prescribe the MAOIs despite the recent resurgence of interest in these agents and the positive literature concerning their safety and efficacy.
A survey was conducted of the use of methylphenidate in British Columbia during a six month period to determine if a disproportionate number of children are being treated with methylphenidate for hyperactivity. The data obtained do not indicate a problem regarding the diagnosis of attention deficit hyperactivity disorder in children. However, the data pertaining to adults indicate that the reasons stated for prescribing methylphenidate are controversial in a significant number of cases.
This study evaluated the prevalence of fluoroquinolone usage and investigated the association between usage and resistance in respiratory isolates of Streptococcus pneumoniae in Canada. Fluoroquinolone susceptibility testing was conducted on S. pneumoniae collected from 25 medical centres across Canada over nine study years. Fluoroquinolone prescriptions and consumption figures were derived from data in the IMS Health, Canada CompuScript Audit. Between 1997 and 2006, 11825 S. pneumoniae isolates were collected. Ciprofloxacin resistance rates increased significantly (P or = 65 years). Outpatient ciprofloxacin and respiratory fluoroquinolone prescriptions increased by 55.6% (38.2 prescriptions/1000 population to 59.4 prescriptions/1000 population; P