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Mortality in schizophrenia

Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study

Published online by Cambridge University Press:  03 January 2018

John L. Waddington ,
Hanafy A. Youssef  and
Anthony Kinsella
John L. Waddington*
Affiliation:
Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin
Hanafy A. Youssef
Affiliation:
St Davnet's Hospital, Monaghan
Anthony Kinsella
Affiliation:
Department of Mathematics, Dublin Institute of Technology, Ireland
*
Professor John L. Waddington, Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland. Fax: 353-1-402 2453; e-mail: [email protected]
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Abstract

Background

Although increased mortality is one of the most consistent and accepted epidemiological findings in schizophrenia, a high rate of suicide appears unable to account fully for this burden which remains poorly understood.

Method

A cohort of 88 in-patients was followed prospectively over a 10-year period and predictors of survival sought among demographic, clinical and treatment variables.

Results

Over the decade, 39 of the 88 patients (44%) died, with no instances of suicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre-terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival: maximum number of antipsychotics given concurrently (relative risk 2.46, 95% C1 1.10-5.47; P=0.03) and absence of co-treatment with an anticholinergic (relative risk 3.33, 95% C1 0.99-11.11; P=0.05).

Conclusions

Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use of antipsychotic polypharmacy. Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation.

Type
Papers
Information
The British Journal of Psychiatry , Volume 173 , Issue 4 , October 1998 , pp. 325 - 329
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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