title: Antipsychotics and mortality in first-onset schizophrenia: prospective Finnish register study with 5-year follow-up.
abstract: OBJECTIVE
  Our aim was to assess the impact of the most commonly used typical and atypical antipsychotics on mortality of patients with first-onset schizophrenia.
  
  
  METHODS
  We conducted a nationwide, register-based, five-year follow-up study of all patients presenting with first-onset of schizophrenia between 1998 and 2003. Details of reimbursed medicines were obtained from the register of Social Insurance Institution.
  
  
  RESULTS
  After adjusting for age, gender, comorbid physical diseases and patient group, the use of second generation antipsychotics (SGAs), especially clozapine, olanzapine and quetiapine, was associated with reduced risk of all-cause mortality in patients with schizophrenia, while clozapine associated with lower suicide risk. First generation antipsychotics (FGAs), specifically levomepromazine, thioridazine or clorprothixene, were associated with increased risk of all-cause mortality. The FGAs, particularly clorprothixene, were associated with decreased suicide mortality. An increased likelihood for cardiovascular deaths was found among users of levomepromazine. In antidepressants, the use of mirtazapine associated with increased risk of suicide.
  
  
  CONCLUSIONS
  Differences exist between FGAs' and SGAs' use in relation to mortality. These differences remain even when the patient's physical illness are taken into account when prescribing antipsychotic medication.
authors: Social and Mental Health Services, City of Oulu, Finland; University of Oulu, Institute of Clinical Medicine, Psychiatry, Oulu, Finland. Electronic address: marjo.kiviniemi@oulu.fi.
authors: Marjo
authors: M
authors: Kiviniemi
authors: Jaana
authors: J
authors: Suvisaari
authors: Heli
authors: H
authors: Koivumaa-Honkanen
authors: Unto
authors: U
authors: Häkkinen
authors: Matti
authors: M
authors: Isohanni
authors: Helinä
authors: H
authors: Hakko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Antidepressant; Antipsychotic; Medication; Mortality; Schizophrenia