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Long-term antipsychotic use and its association with outcomes in schizophrenia – the Northern Finland Birth Cohort 1966

Published online by Cambridge University Press:  23 March 2020

J.M. Moilanen ,
M. Haapea ,
E. Jääskeläinen ,
J.M. Veijola ,
M.K. Isohanni ,
H.J. Koponen  and
J. Miettunen
J.M. Moilanen*
Affiliation:
University of Oulu, Department of Psychiatry, Research Unit of Clinical Neuroscience, Oulu, Finland Oulu University Hospital, Department of Psychiatry, Oulu, Finland Oulu University Hospital, University of Oulu, Medical Research Center Oulu, Oulu, Finland
M. Haapea
Affiliation:
Oulu University Hospital, Department of Psychiatry, Oulu, Finland Oulu University Hospital, University of Oulu, Medical Research Center Oulu, Oulu, Finland Oulu University Hospital, Department of Diagnostic Radiology, Oulu, Finland University of Oulu, Center for Life Course Health Research, Oulu, Finland
E. Jääskeläinen
Affiliation:
University of Oulu, Department of Psychiatry, Research Unit of Clinical Neuroscience, Oulu, Finland Oulu University Hospital, Department of Psychiatry, Oulu, Finland Oulu University Hospital, University of Oulu, Medical Research Center Oulu, Oulu, Finland University of Oulu, Center for Life Course Health Research, Oulu, Finland
J.M. Veijola
Affiliation:
University of Oulu, Department of Psychiatry, Research Unit of Clinical Neuroscience, Oulu, Finland Oulu University Hospital, Department of Psychiatry, Oulu, Finland Oulu University Hospital, University of Oulu, Medical Research Center Oulu, Oulu, Finland
M.K. Isohanni
Affiliation:
Oulu University Hospital, Department of Psychiatry, Oulu, Finland University of Oulu, Center for Life Course Health Research, Oulu, Finland
H.J. Koponen
Affiliation:
Helsinki University Hospital, University of Helsinki, Psychiatry, Helsinki, Finland
J. Miettunen
Affiliation:
University of Oulu, Department of Psychiatry, Research Unit of Clinical Neuroscience, Oulu, Finland Oulu University Hospital, Department of Psychiatry, Oulu, Finland Oulu University Hospital, University of Oulu, Medical Research Center Oulu, Oulu, Finland University of Oulu, Center for Life Course Health Research, Oulu, Finland
*
⁎Corresponding author. University of Oulu, Department of Psychiatry, Research Unit of Clinical Neuroscience, P.O. Box 5000, 90014 Oulu, Finland. Tel.: +358 440690706; fax: +358 8 336169. [email protected]
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Abstract

Background

Due to the paucity of previous studies, we wanted to elucidate the pharmacoepidemiology of antipsychotics in schizophrenia in a general population sample, and the association between long-term antipsychotic use and outcomes.

Methods

The sample included 53 schizophrenia subjects from the Northern Finland Birth Cohort 1966 with at least ten years of follow-up (mean 18.6 years since illness onset). Data on lifetime medication and outcomes (remission, Clinical Global Impression [CGI], Social and Occupational Functioning Assessment Scale [SOFAS]) were collected from medical records, interviews, and national registers.

Results

During the first two years 22 (42%), between two to five years 17 (32%), and between five to ten years 14 (26%) subjects had used antipsychotics less than half of the time. Drug-free periods became rarer during the follow-up. The mean lifetime daily dose of antipsychotics was 319 mg in chlorpromazine equivalents. A high lifetime average and cumulative dose and antipsychotic polypharmacy were associated with a poorer outcome in all measures, whereas having no drug-free periods was associated with a better SOFAS score and a low proportion of time on antipsychotics with a better CGI score.

Conclusions

In our population-based sample, the use of antipsychotics increased during the first five years of illness and was relatively stable after that. Our results suggest that both low dose and proportion of use, and having no drug-free periods, are associated with better outcomes, which concords with current treatment recommendations and algorithms. High long-term doses and polypharmacy may relate to poor outcomes.

Keywords

AntipsychoticsSchizophreniaLong-termOutcome
Type
Original article
Information
European Psychiatry , Volume 36 , August 2016 , pp. 7 - 14
Copyright
Copyright © European Psychiatric Association 2016

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