Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study.
OBJECTIVE
To study the association between prescribed antipsychotic drugs and outcome in schizophrenia or schizoaffective disorder in the community.


METHODS
Prospective cohort study using national central registers.


METHODS
Community care in Finland.


METHODS
Nationwide cohort of 2230 consecutive adults hospitalised in Finland for the first time because of schizophrenia or schizoaffective disorder, January 1995 to December 2001.


METHODS
Rates of discontinuation of drugs (all causes), rates of rehospitalisation, and mortality associated with monotherapy with the 10 most commonly used antipsychotic drugs. Multivariate models and propensity score methods were used to adjust estimates of effectiveness.


RESULTS
Initial use of clozapine (adjusted relative risk 0.17, 95% confidence interval 0.10 to 0.29), perphenazine depot (0.24, 0.13 to 0.47), and olanzapine (0.35, 0.18 to 0.71) were associated with the lowest rates of discontinuation for any reason when compared with oral haloperidol. During an average follow-up of 3.6 years, 4640 cases of rehospitalisation were recorded. Current use of perphenazine depot (0.32, 0.22 to 0.49), olanzapine (0.54, 0.41 to 0.71), and clozapine (0.64, 0.48 to 0.85) were associated with the lowest risk of rehospitalisation. Use of haloperidol was associated with a poor outcome among women. Mortality was markedly raised in patients not taking antipsychotics (12.3, 6.0 to 24.1) and the risk of suicide was high (37.4, 5.1 to 276).


CONCLUSIONS
The effectiveness of first and second generation antipsychotics varies greatly in the community. Patients treated with perphenazine depot, clozapine, or olanzapine have a substantially lower risk of rehospitalisation or discontinuation (for any reason) of their initial treatment than do patients treated with haloperidol. Excess mortality is seen mostly in patients not using antipsychotic drugs.
Tiihonen
Jari
J
Department of Forensic Psychiatry, University of Kuopio, Niuvanniemi Hospital, FIN-70240 Kuopio, Finland. jari.tiihonen@niuva.fi
Wahlbeck
Kristian
K
Lönnqvist
Jouko
J
Klaukka
Timo
T
Ioannidis
John P A
JP
Volavka
Jan
J
Haukka
Jari
J
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome; D016312:Treatment Refusal
D014150:Antipsychotic Agents