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Antipsychotics and risk of natural death in patients with schizophrenia

Authors Chen Y, Yang X, Qin X, Yang Q, Fan H, Li J, Song X, Xu S, Guo W, Deng W, Wang Q, Li T, Ma X

Received 28 December 2018

Accepted for publication 4 May 2019

Published 5 July 2019 Volume 2019:15 Pages 1863—1871

DOI https://doi.org/10.2147/NDT.S199748

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Yu-Ping Ning


Yayun Chen,1,2 Xiao Yang,1,2 Xiaorong Qin,3 Qin Yang,3 Huanhuan Fan,1,2 Jun Li,4 Xiuli Song,1,2 Shuang Xu,4 Wanjun Guo,1,2 Wei Deng,1,2 Qiang Wang,1,2 Tao Li,1,2 Xiaohong Ma1,2

1Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 2Huaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 3Community Mental Health Prevention Department, The Severe Mental Health Disorder System of Chengdu, Chengdu, Sichuan, People’s Republic of China; 4Department of Geriatric Psychiatry, Sichuan Province Recover Veterans Hospital, Chongzhou, Sichuan, People’s Republic of China

Background: Research on antipsychotics and early mortality in schizophrenia has arisen from Western countries and results show that mortality from natural causes is obviously increased in schizophrenia. China, differs largely from Western countries in health and social welfare systems, and Asian patients are more susceptible to side-effects and might require less antipsychotics than their Western counterparts. We, therefore, investigated the association between antipsychotic use and increased mortality from natural causes among patients with schizophrenia in China.
Methods: We conducted a population-based nested case–control study using patients’ hardcopy archives obtained from the Severe Mental Health Disorder Systems of Chengdu between January 1, 2006 and December 31, 2013. We identified all schizophrenic patients aged 18–65 years who died of natural causes in 2013 (N=157), and their age- and gender-matched controls (N=444).
Results: Antipsychotic use was more frequent in controls than in cases (59.9% vs 32.5%). Risk of death decreased significantly in those receiving antipsychotic monotherapy (adjusted odds ratio=0.27, 95% CI=0.16–0.46) and antipsychotic polypharmacy (adjusted odds ratio=0.29, 95% CI=0.12–0.70) than antipsychotic-free patients. Compared with monotherapy, antipsychotic-free treatment was associated with prominently increased mortality (adjusted odds ratio=3.64, 95% CI=2.18–6.08). When stratified by age and gender, the results remained unchanged.
Conclusion: Antipsychotic monotherapy significantly decreased mortality from natural causes in schizophrenic patients while antipsychotic polypharmacy did not contribute to the excess mortality and deserves further clarification. We need to improve the physical health of schizophrenic patients and promote health education among community mental health staff and primary caregivers.

Keywords: antipsychotics, polypharmacy, mortality, odds ratio, schizophrenia


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