Suicide risk and antipsychotic side effects in schizophrenia: nested case-control study.
This study explores suicide risk in schizophrenia in relation to side effects from antipsychotic medication.



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.



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.



A lower suicide risk identified among patients with EPS could potentially reflect higher antipsychotic adherence, exposure to higher dosage, or polypharmacy among these patients. Copyright © 2016 John Wiley & Sons, Ltd.
Centre for Pharmacoepidemiology (CPE), Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Johan
0000-0003-1372-4262
J
Reutfors
Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
Eric
E
Clapham
Centre for Pharmacoepidemiology (CPE), Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.|Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
Shahram
S
Bahmanyar
Centre for Pharmacoepidemiology (CPE), Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Lena
L
Brandt
Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.|NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Erik G
EG
Jönsson
Centre for Pharmacoepidemiology (CPE), Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Anders
A
Ekbom
Centre for Pharmacoepidemiology (CPE), Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.|Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
Robert
0000-0002-2198-8842
R
Bodén
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.|Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.|Department of Adult Psychiatry, PRIMA Psychiatry AB, Stockholm, Sweden.
Urban
U
Ösby
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012565:Schizophrenic Psychology; D016037:Single-Blind Method; D013405:Suicide / Q000523:psychology*; D055815:Young Adult; D000092864:Suicide Prevention
D014150:Antipsychotic Agents
akathisia; antipsychotics; schizophrenia; side effects; suicide