scholarly journals Associations between individual antipsychotics and the risk of arrests and convictions of violent and other crime: a nationwide within-individual study of 74 925 persons

2021 ◽  
pp. 1-9
Author(s):  
Amir Sariaslan ◽  
Stefan Leucht ◽  
Johan Zetterqvist ◽  
Paul Lichtenstein ◽  
Seena Fazel
Keyword(s):  
Fixed Effects ◽  
First Generation ◽  
Mood Stabilizer ◽  
Relative Risks ◽  
Second Generation Antipsychotics ◽  
Adjusted Rate ◽  
Long Acting ◽  
Rate Ratios ◽  
Combined Medication ◽  
Unmeasured Confounders

Abstract Background Individuals diagnosed with psychiatric disorders who are prescribed antipsychotics have lower rates of violence and crime but the differential effects of specific antipsychotics are not known. We investigated associations between 10 specific antipsychotic medications and subsequent risks for a range of criminal outcomes. Methods We identified 74 925 individuals who were ever prescribed antipsychotics between 2006 and 2013 using nationwide Swedish registries. We tested for five specific first-generation antipsychotics (levomepromazine, perphenazine, haloperidol, flupentixol, and zuclopenthixol) and five second-generation antipsychotics (clozapine, olanzapine, quetiapine, risperidone, and aripiprazole). The outcomes included violent, drug-related, and any criminal arrests and convictions. We conducted within-individual analyses using fixed-effects Poisson regression models that compared rates of outcomes between periods when each individual was either on or off medication to account for time-stable unmeasured confounders. All models were adjusted for age and concurrent mood stabilizer medications. Results The relative risks of all crime outcomes were substantially reduced [range of adjusted rate ratios (aRRs): 0.50–0.67] during periods when the patients were prescribed antipsychotics v. periods when they were not. We found that clozapine (aRRs: 0.28–0.44), olanzapine (aRRs: 0.46–0.72), and risperidone (aRRs: 0.53–0.64) were associated with lower arrest and conviction risks than other antipsychotics, including quetiapine (aRRs: 0.68–0.84) and haloperidol (aRRs: 0.67–0.77). Long-acting injectables as a combined medication class were associated with lower risks of the outcomes but only risperidone was associated with lower risks of all six outcomes (aRRs: 0.33–0.69). Conclusions There is heterogeneity in the associations between specific antipsychotics and subsequent arrests and convictions for any drug-related and violent crimes.

Antipsychotic utilisation and persistence in Australia: A nationwide 5-year study

2021 ◽  
pp. 000486742110516
Author(s):  
Mark Taylor ◽  
Dante Dangelo-Kemp ◽  
Dennis Liu ◽  
Steve Kisely ◽  
Simon Graham ◽  
...  
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Treatment Persistence ◽  
Persistence Time ◽  
Hazard Ratios ◽  
Second Generation Antipsychotics ◽  
Time In Treatment ◽  
Second Generation Antipsychotic ◽  
Long Acting ◽  
Subsequent Relapse

Objectives: To evaluate the utilisation and persistence of antipsychotics for the treatment of schizophrenia in Australia. Methods: A retrospective study using the Australian Pharmaceutical Benefits Scheme database of a representative 10% sample. All adults with schizophrenia who were dispensed three or more supplies of oral (including clozapine) or long-acting injectable antipsychotics between 1 June 2015 and 31 May 2020 were included. Persistence time in treatment was evaluated using survival analysis and Cox hazard ratios. Results: In all, 26,847 adults with schizophrenia were studied. Oral second-generation antipsychotics were more frequently dispensed than the other antipsychotic groups studied. Median treatment persistence times were 18.3 months for second-generation antipsychotic long-acting injectables, 10.7 months for oral second-generation antipsychotics and were significantly lower for both formulations of first-generation antipsychotics at 5.2 months (long-acting injectables) and 3.7 months (oral). The median persistence time for clozapine was significantly longer than all other antipsychotics groups. Conclusions: Oral second-generation antipsychotics and second-generation antipsychotic long-acting injectables accounted for over 75% and 13% of all antipsychotics in Australia, respectively. Concerns over medication adherence and subsequent relapse have not translated into increased long-acting injectable usage despite their significantly longer persistence. Clozapine, the single most ‘persistent’ antipsychotic, was only used in 9% of people, although up to a third of all cases are likely to be treatment-resistant. Our data suggest clinicians should give consideration to the earlier use of second-generation antipsychotic long-acting injectables and clozapine, to ameliorate prognosis in schizophrenia.

Changes in Body Mass and Metabolic Profiles in Patients with First-Episode Schizophrenia Treated for 12 Months with A First-Generation Antipsychotic

2015 ◽  
Vol 30 (2) ◽  
pp. 277-283 ◽  
Author(s):  
B. Chiliza ◽  
L. Asmal ◽  
P. Oosthuizen ◽  
E. van Niekerk ◽  
R. Erasmus ◽  
...  
Keyword(s):  
Body Mass ◽  
First Generation ◽  
Fasting Blood Glucose ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Metabolic Profiles ◽  
Second Generation Antipsychotics ◽  
Developing Communities ◽  
Long Acting ◽  
First Episode Schizophrenia

AbstractObjectives:To assess changes in body mass and metabolic profiles in patients with first-episode schizophrenia receiving standardised, assured treatment and to identify predictors and moderators of the effects.Methods:We investigated the changes in body mass, fasting blood glucose and lipids in 107 largely antipsychotic naïve, first-episode schizophrenia patients who were treated according to a standard algorithm with long-acting injectable flupenthixol decanoate over 12 months.Results:Eighty-three (78%) participants completed the 12 months of treatment, and 104 (97%) received 100% of the prescribed injections during their participation. There were significant increases in BMI (P < .0001), waist circumference (P = 0.0006) and triglycerides (P = 0.03) and decrease in HDL (P = 0.005), while systolic (P = 0.7) and diastolic blood pressure (P = 0.8), LDL (P = 0.1), cholesterol (P = 0.3), and glucose (P = 0.9) values did not change over time. The triglyceride: HDL ratio increased by 91%. Change in BMI was only correlated with change in triglycerides (P = .008). The only significant predictor of BMI increase was non-substance abuse (P = .002).Conclusions:The risks of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics. This is a global problem, and developing communities may be particularly susceptible.

scholarly journals T213. TREND OF LONG-ACTING INJECTABLE ANTIPSYCHOTICS USE IN ASIA: FINDINGS FROM REAP ANTIPSYCHOTIC STUDIES

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S313-S314
Author(s):  
Shih-Ku Lin ◽  
An-Nie Chung
Keyword(s):  
Hong Kong ◽  
First Generation ◽  
Second Generation ◽  
Average Rate ◽  
Insurance Coverage ◽  
Antipsychotic Treatment ◽  
Prescription Rate ◽  
Second Generation Antipsychotics ◽  
Steady Level ◽  
Long Acting

Abstract Background Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia since 2001. At present, four studies on antipsychotics in schizophrenia, two antidepressants, one bipolar disorder and one mood disorder were completed. Previous studies have examined the use of Long-acting Injectable (LAI) antipsychotic in patients with schizophrenia and revealed major differences across countries. The aim of the study is to investigate the prescription trend of LAI antipsychotic use in four REAP schizophrenia surveys. Methods We analyzed the results from four times of REAP studies (AP1 to AP4, 2001, 2004, 2009 and 2016), to compare the trend of LAI prescriptions rates in China, Hong Kong, Japan, Korea, Singapore, and Taiwan, and also the rate of LAI use among 15 Asian countries in AP4. Results A total of 10505 patients were analyzed, with an average rate of 14.6% of patients received LAI antipsychotic treatment. For comparison of AP1 to AP4, there was a wide variation in the rate of LAI use among the six countries, with the highest prescription rate in Singapore (68.1%) and the lowest in Korea (1.6 %). Korean patients received no LAIs treatment in the first two surveys, and the rates in China and Japan were also very low. While in Hong Kong and Singapore, the rates were much higher. In AP4 survey, India, Malaysia, Thailand, Pakistan and Sri Lanka have a higher rate of LAI use, while in Indonesia, Myanmar, the rate is much lower. Vietnam does not use LAI at all. The prescription trend was also diverse, which increased in Korea and Japan and decreased in China, Hong Kong and Singapore. The overall prescription trend of LAI was in decrease. Besides, when analyzing cases with only using second generation antipsychotics, the usage of LAI was increased. Discussion Previous studies identified several factors associated with prescription of LAI, including demographic and clinical characteristics of patients, patients’ and physicians’ attitude towards LAI, availability of LAI, insurance coverage and related cultural factors. The prescription trend of first generation LAI was decreased in most of the six countries; on the other hand, second generation LAI usages maintain steady level and even slightly increased. In conclusion, LAI antipsychotic is still underuse in Asia, especially in some countries such as Korea, China, Japan, Indonesia and Myanmar. Various factors that influenced the prescription rate of LAI antipsychotic should be addressed further.

Examining long-acting injectable antipsychotic (depot) medication in the elderly: a 5-year retrospective cross-sectional study evaluating depot use in an Australian psychogeriatric service

2021 ◽  
pp. 103985622110299
Author(s):  
Urvasi Doolabh ◽  
Sherlyn Yeap
Keyword(s):  
First Generation ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Community Treatment ◽  
Cross Sectional ◽  
Second Generation Antipsychotics ◽  
Monthly Injection ◽  
Long Acting ◽  
Relapse Rates ◽  
Depot Medication

Objective: The primary aim was to examine the use of long-acting injectable (LAI) antipsychotic (depot) medication in a cohort of older patients in a community psychogeriatric service. Method: From 2014 to 2018, all patients who were on LAIs each year were analysed for various characteristics including their profile, type of LAI used, dose and relapse rates related to switching, ceasing and community treatment order (CTO) use. Results: A total of 880 patients were managed by the service with 142 recorded cases of LAI use in total over the 5 years (16.1%). Second-generation antipsychotics (SGAs) outnumbered first-generation antipsychotics (FGAs) by 2:1, with a trend of increasing use of SGA LAIs. The most commonly used LAI was Paliperidone monthly injection (PP1M) (50.7%). Lower than usual adult chlorpromazine equivalent daily doses of LAIs were used. The relapse rate while on a LAI was 13.4%. Moreover, 54.9% of the patients on LAIs were on a CTO. Relapse rates were lower on LAIs in combination with a CTO (7.7%). Conclusions: LAIs, especially the SGAs, are increasingly used in our service. In combination with a CTO, LAIs are an effective treatment in reducing relapse rates in the elderly.

Pharmakotherapie update

2020 ◽  
Vol 25 (1) ◽  
pp. 23-32
Author(s):  
Gerd Laux
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Therapeutische Maßnahmen ◽  
Second Generation Antipsychotics

Für die Therapie schizophrener Erkrankungen sind seit fast 60 Jahren Antipsychotika/Neuroleptika aufgrund ihrer antipsychotischen Wirkung von zentraler Bedeutung. Die Einteilung kann unter verschiedenen Gesichtspunkten erfolgen (chemische Struktur, neuroleptische Potenz, Rezeptorprofil), heute werden üblicherweise unterschieden typische (traditionelle, klassische, konventionelle) Antipsychotika der ersten Generation ‒ »First Generation Antipsychotics« (FGA) ‒ und sog. atypische (»neuere«) Neuroleptika bzw. Antipsychotika der zweiten Generation ‒»Second Generation Antipsychotics« (SGA). Hierzu zählen Aripiprazol, Asenapin, Cariprazin, Clozapin, Olanzapin, Quetiapin, Risperidon, Sertindol und Ziprasidon. Hierbei handelt es sich um keine homogene Gruppe – sowohl neuropharmakologisch (Wirkmechanismus), als auch hinsichtlich klinischem Wirkprofil und dem Nebenwirkungsspektrum bestehen z. T. erhebliche Unterschiede. Neben der Akut-Medikation ist eine Langzeitmedikation bzw. Rezidivprophylaxe mit Antipsychotika für die Rehabilitation vieler schizophrener Patienten im Sinne eines »Stresspuffers« von grundlegender Bedeutung. In Placebo-kontrollierten Studien trat bei Patienten, die über ein Jahr behandelt wurden, bei etwa 30% unter Neuroleptika ein Rezidiv auf, unter Placebo bei mehr als 70%. Für die Langzeitbehandlung bietet sich der Einsatz von Depot-Neuroleptika an, neu entwickelt wurden Langzeit-Depot-Injektionen mit Intervallen von bis zu 3 Monaten. Grundsätzlich ist die niedrigstmögliche (wirksame) Dosis zu verwenden. Im Zentrum der Nebenwirkungen (UAW) standen lange Zeit extrapyramidal-motorische Bewegungsstörungen (EPMS), mit der Einführung von Clozapin und anderen atypischen Antipsychotika der zweiten Generation gewannen andere Nebenwirkungen an Bedeutung. Hierzu zählen Gewichtszunahme, Störungen metabolischer Parameter und ein erhöhtes Risiko für Mortalität und zerebrovaskuläre Ereignisse bei älteren Patienten mit Demenz. Entsprechende Kontrolluntersuchungen sind erforderlich, für Clozapin gibt es aufgrund seines Agranulozytose-Risikos Sonderbestimmungen. Immer sollte ein Gesamtbehandlungsplan orientiert an der neuen S3-Praxisleitlinie Schizophrenie der DGPPN aufgestellt werden, der psychologische und milieu-/sozial-therapeutische Maßnahmen einschließt. Standard ist heute auch eine sog. Psychoedukation, für Psychopharmaka liegen bewährte Patienten-Ratgeber vor.

Abstract P259: Smoking Increases Risks of Death and Stroke in Both Men and Women. Absolute Risk Difference of Stroke is Likely to be Larger in Women

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Masaki Ohsawa ◽  
Kuniaki Ogasawara ◽  
Shinichi Omama ◽  
Kozo Tanno ◽  
Kazuyoshi Itai ◽  
...  
Keyword(s):  
Smoking Status ◽  
Absolute Risk ◽  
Incidence Rates ◽  
Risk Difference ◽  
Current Smoker ◽  
Men And Women ◽  
Risk Of Death ◽  
Adjusted Rate ◽  
Never Smokers ◽  
Rate Ratios

Background: Smoking is an important risk factor for cardiovascular disease, however, to what extent smoking increases excessive deaths and strokes in a general population has not been sufficiently examined especially in women. Methods: A total of 10,382 female and male participants aged 65 years or older were divided into two groups according to smoking status (current smoker; never smoker). Past smokers were excluded. Main outcomes were all-cause death and incident stroke. Age-adjusted mortality and incidence rates were estimated in the groups using Poisson’s regression analysis. Age-adjusted rate ratios (RR) and excess events (EE per 1000 person-years) attributable to smoking were determined using the rate in never smokers as a reference. Results: There were 1410 deaths and 735 strokes during the 9.0-year observation period (90,099 person-years). Smoking contributed to a 2.3-fold higher risk of death in women and 1.8-fold higher risk in men. It contributed to 12 excess deaths per 1000 person-years in both men and women. The rate ratio and excessive events of stroke were likely to be higher in women than those in men (RR: 2.6 vs. 1.6; EE: 9.3 vs 5.0, see table). Conclusion: Smoking significantly increases risks of death and stroke not only in men but also in women. Absolute risk difference of stroke attributable to smoking is likely to be larger in women than in men.

scholarly journals First-generation versus second-generation long-acting injectable antipsychotic drugs and time to relapse

2018 ◽  
Vol 8 (12) ◽  
pp. 333-336 ◽  
Author(s):  
James M. Stone ◽  
Simon Roux ◽  
David Taylor ◽  
Paul D. Morrison
Keyword(s):  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Patient Acceptability ◽  
Inpatient Ward ◽  
Medication Discontinuation ◽  
Kaplan Meier ◽  
The Difference ◽  
Long Acting ◽  
Time To Relapse

Background: The development of long-acting injectable formulations (LAIs) of second-generation antipsychotic drugs (SGAs) has been suggested as having advantage over first-generation antipsychotic (FGA) LAIs. In this study, we investigated the hypothesis that there was a longer time to relapse in patients with schizophrenia started on SGA LAI versus FGA LAI. Methods: Patients with a diagnosis of schizophrenia or schizoaffective disorder who were started on an SGA LAI while on an inpatient ward were identified through searching of the anonymised historical medical records at the South London and Maudsley NHS Foundation Trust. Patients starting FGA LAIs matched for diagnosis, age and date of hospital admission were identified. Time to readmission, discontinuation of LAI or death were identified. Kaplan–Meier plots were generated for each group, and the difference between groups analysed using log-rank methods. Results: There were 157 patients identified in each group. There was no difference in time to readmission, medication discontinuation or death in patients on SGA LAI versus FGA LAI. Conclusions: We found no evidence of advantage in terms of maintaining response in SGA LAI versus FGA LAI. Prescriber choice should be guided by other factors such as side-effect profile, patient acceptability and price.

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