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11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study).

https://arctichealth.org/en/permalink/ahliterature149701
Source
Lancet. 2009 Aug 22;374(9690):620-7
Publication Type
Article
Date
Aug-22-2009
Author
Jari Tiihonen
Jouko Lönnqvist
Kristian Wahlbeck
Timo Klaukka
Leo Niskanen
Antti Tanskanen
Jari Haukka
Author Affiliation
Department of Forensic Psychiatry, University of Kuopio and Niuvanniemi Hospital, Department of Clinical Physiology, Kuopio University Hospital, Kuopio, Finland. jari.tiihonen@niuva.fi
Source
Lancet. 2009 Aug 22;374(9690):620-7
Date
Aug-22-2009
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Antipsychotic Agents - adverse effects
Case-Control Studies
Cause of Death
Clozapine - adverse effects
Dibenzothiazepines - adverse effects
Drug Utilization - trends
Female
Finland - epidemiology
Follow-Up Studies
Health Status Disparities
Humans
Life expectancy
Male
Middle Aged
Patient Readmission - statistics & numerical data
Perphenazine - adverse effects
Proportional Hazards Models
Registries
Risk factors
Schizophrenia - drug therapy - mortality
Sex Distribution
Time Factors
Abstract
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
Notes
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
PubMed ID
19595447 View in PubMed
Less detail

14-year outcome in early schizophrenia.

https://arctichealth.org/en/permalink/ahliterature248211
Source
Acta Psychiatr Scand. 1978 Oct;58(4):327-38
Publication Type
Article
Date
Oct-1978
Author
R C Bland
H. Orn
Source
Acta Psychiatr Scand. 1978 Oct;58(4):327-38
Date
Oct-1978
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Canada
Female
Fertility
Follow-Up Studies
Humans
Length of Stay
Male
Marriage
Prognosis
Schizophrenia - drug therapy - mortality
Sex Factors
Social Adjustment
Socioeconomic Factors
Abstract
Of 45 first admission schizophrenics from 1963, an incidence by first admission group for northern Alberta, 43 were followed-up 14 years later. Based on these figures the expectancy was found to be 0.49%. The proportion of patients who were married was less than expected in comparison with the general population, but amongst the married, fertility was probably comparable to the population's. At follow-up about half the patients were managing well with little or no disability, one quarter had moderate to marked disability and the remainder were socially, psychiatrically and occupationally disabled. From the time of first admission, patients had spent an average of 15% of their time in hospital and lost 28% of the total time due to psychiatric disability.
PubMed ID
717003 View in PubMed
Less detail

20-Year Nationwide Follow-Up Study on Discontinuation of Antipsychotic Treatment in First-Episode Schizophrenia.

https://arctichealth.org/en/permalink/ahliterature301781
Source
Am J Psychiatry. 2018 08 01; 175(8):765-773
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-01-2018
Author
Jari Tiihonen
Antti Tanskanen
Heidi Taipale
Author Affiliation
From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm; the Department of Forensic Psychiatry, University of Eastern Finland, and Niuvanniemi Hospital, Kuopio; the Impact Assessment Unit, National Institute for Health and Welfare, Helsinki; and the School of Pharmacy, University of Eastern Finland, Kuopio.
Source
Am J Psychiatry. 2018 08 01; 175(8):765-773
Date
08-01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Antipsychotic Agents - administration & dosage - therapeutic use
Female
Finland - epidemiology
Follow-Up Studies
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Proportional Hazards Models
Recurrence
Registries
Risk factors
Schizophrenia - drug therapy
Withholding Treatment
Abstract
It is generally believed that after the first episode of schizophrenia, the risk of relapse decreases with time in patients who are stabilized. Many treatment guidelines recommend that after stabilization, antipsychotic treatment should be continued for 1-5 years, and longer exposure should be avoided if possible. However, there is no published evidence to substantiate this view. The authors used nationwide databases to investigate this issue.
Prospectively gathered nationwide register data were used to study the risk of treatment failure (psychiatric rehospitalization or death) after discontinuation of antipsychotic treatment. Multivariate Cox regression was used to assess outcomes among all patients hospitalized for the first time with a schizophrenia diagnosis in Finland during the period of 1996-2014 (N=8,719).
The lowest risk of rehospitalization or death was observed for patients who received antipsychotic treatment continuously (adjusted hazard ratio=1.00), followed by patients who discontinued antipsychotic use immediately after discharge from the first hospital treatment (hazard ratio=1.63, 95% CI=1.52-1.75), within 1 year (hazard ratio=1.88, 95% CI=1.57-2.24), within 1-2 years (hazard ratio=2.12, 95% CI=1.43-3.14), within 2-5 years (hazard ratio=3.26, 95% CI=2.07-5.13), and after 5 years (a median of 7.9 years) (hazard ratio=7.28, 95% CI=2.78-19.05). Risk of death was 174%-214% higher among nonusers and patients with early discontinuation of antipsychotics compared with patients who received antipsychotic treatment continuously for up to 16.4 years.
Whatever the underlying mechanisms, these results provide evidence that, contrary to general belief, the risk of treatment failure or relapse after discontinuation of antipsychotic use does not decrease as a function of time during the first 8 years of illness, and that long-term antipsychotic treatment is associated with increased survival.
Notes
CommentIn: Am J Psychiatry. 2018 Aug 1;175(8):712-713 PMID 30064241
CommentIn: Am J Psychiatry. 2018 Sep 1;175(9):908-909 PMID 30173547
CommentIn: Am J Psychiatry. 2018 Sep 1;175(9):909 PMID 30173555
CommentIn: Am J Psychiatry. 2018 Dec 1;175(12):1266-1267 PMID 30501413
CommentIn: Am J Psychiatry. 2018 Dec 1;175(12):1267 PMID 30501421
PubMed ID
29621900 View in PubMed
Less detail

The adequacy of pharmaceutical treatment of schizophrenia in Quebec varies with age, but is not influenced by sex or neighbourhood deprivation.

https://arctichealth.org/en/permalink/ahliterature107816
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Publication Type
Article
Date
Aug-2013
Author
Frederieke M Brouwers
Josiane Courteau
Jean-Pierre Grégoire
Jocelyne Moisan
Sophie Lauzier
Alain Lesage
Marie-Josée Fleury
Alain Vanasse
Author Affiliation
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Antipsychotic Agents - therapeutic use
Cohort Studies
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Residence Characteristics - statistics & numerical data
Schizophrenia - drug therapy - epidemiology
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.
We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.
Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).
In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
PubMed ID
23972107 View in PubMed
Less detail

Amisulpride, aripiprazole, and olanzapine in patients with schizophrenia-spectrum disorders (BeSt InTro): a pragmatic, rater-blind, semi-randomised trial.

https://arctichealth.org/en/permalink/ahliterature304350
Source
Lancet Psychiatry. 2020 11; 7(11):945-954
Publication Type
Comparative Study
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Research Support, Non-U.S. Gov't
Date
11-2020
Author
Erik Johnsen
Rune A Kroken
Else-Marie Løberg
Maria Rettenbacher
Inge Joa
Tor Ketil Larsen
Solveig Klæbo Reitan
Berit Walla
Renata Alisauskiene
Liss Gøril Anda
Christoffer Bartz-Johannessen
Jan Øystein Berle
Jill Bjarke
Farivar Fathian
Kenneth Hugdahl
Eirik Kjelby
Igne Sinkeviciute
Silje Skrede
Lena Stabell
Vidar M Steen
W Wolfgang Fleischhacker
Author Affiliation
Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway. Electronic address: erik.johnsen@helse-bergen.no.
Source
Lancet Psychiatry. 2020 11; 7(11):945-954
Date
11-2020
Language
English
Publication Type
Comparative Study
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Amisulpride - adverse effects - therapeutic use
Antipsychotic Agents - adverse effects - therapeutic use
Aripiprazole - adverse effects - therapeutic use
Female
Humans
Male
Middle Aged
Norway
Olanzapine - adverse effects - therapeutic use
Psychiatric Status Rating Scales
Psychotic Disorders - drug therapy
Schizophrenia - drug therapy
Treatment Outcome
Weight Gain - drug effects
Young Adult
Abstract
Amisulpride, aripiprazole, and olanzapine are first-line atypical antipsychotics that have not previously been compared head-to-head in a pragmatic trial. We aimed to compare the efficacy and safety of these agents in a controlled trial.
This pragmatic, rater-blind, randomised controlled trial was done in three academic centres of psychiatry in Norway, and one in Austria. Eligible patients were aged 18 years or older, met ICD-10 criteria for schizophrenia-spectrum disorders (F20-29), and had symptoms of active psychosis. Eligible patients were randomly assigned to receive oral amisulpride, aripiprazole, or olanzapine. Treatment allocation was open to patients and staff, and starting dose, treatment changes, and adjustments were left to the discretion of the treating physician. Computer-generated randomisation lists for each study centre were prepared by independent statisticians. Patients were followed up for 52 weeks after random assignment, during which assessments were done 8 times by researchers masked to treatment. The primary outcome was reduction of the Positive And Negative Syndrome Scale (PANSS) total score at 52 weeks, and primary analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01446328.
Between Oct 20, 2011, and Dec 30, 2016, we assessed 359 patients for eligibility. 215 patients were excluded (107 did not meet inclusion criteria, 82 declined to participate, 26 other reasons). 144 patients (mean baseline PANSS total estimated score 78·4 [SD 1·4]) were randomly assigned 1:1:1 to receive amisulpride (44 patients), aripiprazole (48 patients) or olanzapine (52 patients). After 52 weeks, the patients allocated to amisulpride had a PANSS total score reduction of 32·7 points (SD 3·1) compared with 21·9 points reduction with aripiprazole (SD 3·9, p=0·027) and 23·3 points with olanzapine (2·9, p=0·025). We observed weight gain and increases of serum lipids and prolactin in all groups. 26 serious adverse events (SAEs) among 20 patients were registered (four [9%] of 44 patients allocated to amisulpride, ten [21%] of 48 patients allocated to aripiprazole, and six [12%] of 52 patients allocated to olanzapine), with no statistically significant differences between the study drugs. 17 (65%) of the 26 SAEs occurred during the use of the study drug, with readmission or protracted hospital admission accounting for 13 SAEs. One death by suicide, one unspecified death, and one life-threatening accident occurred during follow-up, after cessation of treatment.
Amisulpride was more efficacious than aripiprazole or olanzapine for reducing the PANSS total scores in adults with schizophrenia-spectrum disorders. Side-effect differences among the groups were generally small. This study supports the notion that clinically relevant efficacy differences exist between antipsychotic drugs. Future research should aim to compare first-line antipsychotics directly in pragmatic clinical trials that reflect everyday clinical practice.
The Research Council of Norway, the Western Norway Regional Health Trust, and participating hospitals and universities.
Notes
CommentIn: Lancet Psychiatry. 2020 Dec;7(12):1004-1006 PMID 33069272
CommentIn: Lancet Psychiatry. 2021 Feb;8(2):100-101 PMID 33485409
CommentIn: Lancet Psychiatry. 2021 Feb;8(2):101 PMID 33485410
PubMed ID
33069317 View in PubMed
Less detail

Amotivational syndrome: the real management problem of schizophrenia.

https://arctichealth.org/en/permalink/ahliterature255465
Source
Can Med Assoc J. 1972 Jun 10;106(11):1208-10 passim
Publication Type
Article
Date
Jun-10-1972
Author
W N Andrews
M H King
Source
Can Med Assoc J. 1972 Jun 10;106(11):1208-10 passim
Date
Jun-10-1972
Language
English
Publication Type
Article
Keywords
Aftercare
Canada
Fluphenazine - administration & dosage - therapeutic use
Hospitalization
Humans
Motivation
Patient care team
Personality
Phenothiazines - administration & dosage - therapeutic use
Physicians, Family
Schizophrenia - drug therapy - therapy
Abstract
Impaired insight is a prominent feature of the schizophrenic syndrome, and failure to take major tranquillizers by the oral route has resulted in many relapses. The introduction of the long-acting phenothiazine fluphenazine enanthate (Moditen Enanthate) has greatly facilitated the control of the florid symptoms of this disorder by transferring most of the responsibility for phenothiazine administration from the patients to the clinic or family physician. The educational maturing process, to enable these patients to cope with the challenges of adult life and the reality of their condition, can be handled more effectively through a therapeutic team approach, operating within the framework of a structured program, than by the traditional psychiatrist/patient relationship alone.
Notes
Cites: Br Med J. 1965 Oct 2;2(5465):790-25825418
Cites: Br J Psychiatry. 1967 Dec;113(505):1435-96078497
Cites: Psychosomatics. 1968 May-Jun;9(3):166-715661509
Cites: Br Med J. 1968 Nov 9;4(5627):371-34300836
Cites: Dis Nerv Syst. 1970 Sep;31:Suppl:7-95476361
Cites: Br Med J. 1962 Apr 7;1(5283):972-614483944
Cites: Acta Psychiatr Scand. 1963;39:548-60014164125
PubMed ID
4338368 View in PubMed
Less detail

Antipsychotic dosing patterns for schizophrenia in three treatment settings.

https://arctichealth.org/en/permalink/ahliterature196219
Source
Psychiatr Serv. 2001 Jan;52(1):96-8
Publication Type
Article
Date
Jan-2001
Author
G. Remington
C M Shammi
R. Sethna
R. Lawrence
Author Affiliation
Department of Psychiatry, University of Toronto, Ontario, Canada. gary_remington@camh.net
Source
Psychiatr Serv. 2001 Jan;52(1):96-8
Date
Jan-2001
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - administration & dosage
Canada
Chlorpromazine - administration & dosage
Dosage Forms
Drug Utilization - statistics & numerical data
Drug Utilization Review
Female
Guideline Adherence
Hospitals, Community - statistics & numerical data
Hospitals, County - statistics & numerical data
Hospitals, Teaching - statistics & numerical data
Humans
Inpatients - statistics & numerical data
Male
Outpatients - statistics & numerical data
Practice Guidelines as Topic
Retrospective Studies
Schizophrenia - drug therapy
Therapeutic Equivalency
Abstract
Daily dosages of antipsychotic medications were evaluated to determine whether current guidelines advocating lower dosing are being followed. A chart review of 163 outpatients with schizophrenia was undertaken in three outpatient hospital settings-a general community hospital, a provincial hospital, and an academic teaching hospital. The daily dosage in chlorpromazine equivalents was significantly higher in the provincial hospital (773.8 mg) than in the community hospital (355 mg) or the academic hospital (424.8 mg). A greater proportion of patients at the provincial hospital received conventional antipsychotics than novel antipsychotics or depot antipsychotics, and a greater proportion received more than one antipsychotic.
PubMed ID
11141536 View in PubMed
Less detail

Antipsychotic drug--a study of the prescription pattern in a total sample of patients with a schizophrenic syndrome in one catchment area in the county of Uppland, Sweden, in 1991.

https://arctichealth.org/en/permalink/ahliterature210433
Source
Int Clin Psychopharmacol. 1996 Dec;11(4):241-6
Publication Type
Article
Date
Dec-1996
Author
E. Lindström
B. Widerlöv
L. von Knorring
Author Affiliation
Department of Psychiatry, University Hospital, Uppsala, Sweden.
Source
Int Clin Psychopharmacol. 1996 Dec;11(4):241-6
Date
Dec-1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antipsychotic Agents - therapeutic use
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Schizophrenia - drug therapy - epidemiology
Sweden - epidemiology
Abstract
In a total population of patients with a schizophrenic syndrome, the amount of antipsychotic drugs during a defined period was studied. Doses of antipsychotics were higher in males than in females, low to moderate in most patients, and decreased with the duration of illness. There was a significant negative correlation between antipsychotic dose and age at first admission. Compulsory treatment as well as the use of depot preparations were equally common in both sexes. In patients who had been compulsorily admitted, significantly higher doses of antipsychotics were used. The amount of antipsychotics prescribed to a single patient was best explained by the presence or absence of hallucinations and loose associations.
PubMed ID
9031990 View in PubMed
Less detail

[Antipsychotic drug therapy in schizophrenia--new guidelines. The Swedish National Board of Health and Welfare emphasizes the need for continuous treatment].

https://arctichealth.org/en/permalink/ahliterature262421
Source
Lakartidningen. 2014 Oct 1-7;111(40):1704-5
Publication Type
Article

211 records – page 1 of 22.