Johan Reutfors1, Eric Clapham2, Shahram Bahmanyar1,3, Lena Brandt1, Erik G Jönsson4,5, Anders Ekbom1, Robert Bodén1,2, Urban Ösby6,7,8. 1. Centre for Pharmacoepidemiology (CPE), Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden. 3. Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. 4. Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 5. NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 6. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. 7. Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden. 8. Department of Adult Psychiatry, PRIMA Psychiatry AB, Stockholm, Sweden.
Abstract
OBJECTIVE: This study explores suicide risk in schizophrenia in relation to side effects from antipsychotic medication. METHODS: Among patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4000), those who died by suicide within 5 years from diagnosis were defined as cases (n = 84; 54% male). For each case, one individually matched control was identified from the same population. Information on antipsychotic side effects, including extrapyramidal symptoms (EPS) and akathisia, as well as prescriptions of anticholinergic medication, was retrieved from clinical records in a blinded fashion. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of the association between suicide and side effects as well as anticholinergic medication were estimated using conditional logistic regression. RESULTS: A lower suicide risk was found in patients with a history of EPS (aOR 0.33, 95% CI 0.12-0.94). There was no statistically significant association between akathisia or anticholinergic medication use and the suicide risk. CONCLUSIONS: A lower suicide risk identified among patients with EPS could potentially reflect higher antipsychotic adherence, exposure to higher dosage, or polypharmacy among these patients.
OBJECTIVE: This study explores suicide risk in schizophrenia in relation to side effects from antipsychotic medication. METHODS: Among patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4000), those who died by suicide within 5 years from diagnosis were defined as cases (n = 84; 54% male). For each case, one individually matched control was identified from the same population. Information on antipsychotic side effects, including extrapyramidal symptoms (EPS) and akathisia, as well as prescriptions of anticholinergic medication, was retrieved from clinical records in a blinded fashion. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of the association between suicide and side effects as well as anticholinergic medication were estimated using conditional logistic regression. RESULTS: A lower suicide risk was found in patients with a history of EPS (aOR 0.33, 95% CI 0.12-0.94). There was no statistically significant association between akathisia or anticholinergic medication use and the suicide risk. CONCLUSIONS: A lower suicide risk identified among patients with EPS could potentially reflect higher antipsychotic adherence, exposure to higher dosage, or polypharmacy among these patients.
Authors: Tamara Pringsheim; David Gardner; Donald Addington; Davide Martino; Francesca Morgante; Lucia Ricciardi; Norman Poole; Gary Remington; Mark Edwards; Alan Carson; Thomas R E Barnes Journal: Can J Psychiatry Date: 2018-04-23 Impact factor: 4.356
Authors: Maurizio Pompili; Ross J Baldessarini; Alberto Forte; Denise Erbuto; Gianluca Serafini; Andrea Fiorillo; Mario Amore; Paolo Girardi Journal: Int J Mol Sci Date: 2016-10-11 Impact factor: 5.923