Long‐term antipsychotic polypharmacy prescribing in secondary mental health care and the risk of mortality

TY - JOUR

T1 - Long‐term antipsychotic polypharmacy prescribing in secondary mental health care and the risk of mortality

AU - Kadra-Scalzo, G.

AU - Stewart, R.

AU - Shetty, H.

AU - MacCabe, J. H.

AU - Chang, C.-K.

AU - Taylor, D.

AU - Hayes, R. D.

N1 - © 2018 The Authors Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.

PY - 2018/8

Y1 - 2018/8

N2 - Objectives To investigate the association between long‐term antipsychotic polypharmacy use and mortality; and determine whether this risk varies by cause of death and antipsychotic dose. Methods Using data from a large anonymised mental healthcare database, we identified all adult patients with serious mental illness (SMI) who had been prescribed a single antipsychotic or polypharmacy, for six or more months between 2007 and 2014. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical factors and smoking, to examine the association between APP use and the risk of death. Results We identified 10 945 adults with SMI who had been prescribed long‐term antipsychotic monotherapy (76.9%) or APP (23.1%). Patients on long‐term APP had a small elevated risk of mortality, which was significant in some but not all models. The adjusted hazard ratios for death from natural and unnatural causes associated with APP were 1.2 (0.9–1.4, P = 0.111) and 1.1 (0.7–1.9, P = 0.619) respectively. The strengths of the associations between APP and mortality outcomes were similar after further adjusting for % BNF antipsychotic dose (P = 0.031) or olanzapine equivalence (P = 0.088). Conclusion The findings suggest that the effect of long‐term APP on mortality is not clear‐cut, with limited evidence to indicate an association, even after controlling for the effect of dose.

AB - Objectives To investigate the association between long‐term antipsychotic polypharmacy use and mortality; and determine whether this risk varies by cause of death and antipsychotic dose. Methods Using data from a large anonymised mental healthcare database, we identified all adult patients with serious mental illness (SMI) who had been prescribed a single antipsychotic or polypharmacy, for six or more months between 2007 and 2014. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical factors and smoking, to examine the association between APP use and the risk of death. Results We identified 10 945 adults with SMI who had been prescribed long‐term antipsychotic monotherapy (76.9%) or APP (23.1%). Patients on long‐term APP had a small elevated risk of mortality, which was significant in some but not all models. The adjusted hazard ratios for death from natural and unnatural causes associated with APP were 1.2 (0.9–1.4, P = 0.111) and 1.1 (0.7–1.9, P = 0.619) respectively. The strengths of the associations between APP and mortality outcomes were similar after further adjusting for % BNF antipsychotic dose (P = 0.031) or olanzapine equivalence (P = 0.088). Conclusion The findings suggest that the effect of long‐term APP on mortality is not clear‐cut, with limited evidence to indicate an association, even after controlling for the effect of dose.

UR - https://www.scopus.com/pages/publications/85047667206

U2 - 10.1111/acps.12906

DO - 10.1111/acps.12906

M3 - Article

C2 - 29845597

SN - 0001-690X

VL - 138

SP - 123

EP - 132

JO - Acta Psychiatrica Scandinavica

JF - Acta Psychiatrica Scandinavica

IS - 2

ER -