Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study
Identifieur interne : 009A57 ( Main/Exploration ); précédent : 009A56; suivant : 009A58Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study
Auteurs : J. L. Waddington [Irlande (pays)] ; H. A. Youssef [Irlande (pays)] ; A. Kinsella [Irlande (pays)]Source :
- British journal of psychiatry [ 0007-1250 ] ; 1998.
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Abstract
Background Although increased mortality is one ofthe most consistent and accepted epidemiological findings in schizophrenia, a high rate ofsuicide appears unable to account fully for this burden which remains poorly understood. Method A cohort of 88 in-patients was followed prospectively over a 10-year period and predictors of survival sought among demographic, clinical and treatment variables. Results Over the decade, 39 of the 88 patients (44%) died, with no instances ofsuicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre-terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival : maximum number of antipsychotics given concurrently (relative risk 2.46, 95% Cl 1.10- 5.47; P=0.03) and absence of co-treatment with an anticholinergic (relative risk 3.33, 95% Cl 0.99-11.1; P=0.05). Conclusions Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use ofantipsychotic polypharmacy.Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation.
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Youssef</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>St Davnet's Hospital</s1><s2>Monaghan</s2><s3>IRL</s3><sZ>2 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>St Davnet's Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Kinsella, A" sort="Kinsella, A" uniqKey="Kinsella A" first="A." last="Kinsella">A. Kinsella</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Mathematics, Dublin Institute of Technology</s1><s3>IRL</s3><sZ>3 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>Department of Mathematics, Dublin Institute of Technology</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">98-0503558</idno><date when="1998">1998</date><idno type="stanalyst">PASCAL 98-0503558 INIST</idno><idno type="RBID">Pascal:98-0503558</idno><idno type="wicri:Area/PascalFrancis/Corpus">000747</idno><idno type="wicri:Area/PascalFrancis/Curation">000B25</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000746</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000746</idno><idno type="wicri:doubleKey">0007-1250:1998:Waddington J:mortality:in:schizophrenia</idno><idno type="wicri:Area/Main/Merge">009F28</idno><idno type="wicri:Area/Main/Curation">009A57</idno><idno type="wicri:Area/Main/Exploration">009A57</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study</title><author><name sortKey="Waddington, J L" sort="Waddington, J L" uniqKey="Waddington J" first="J. L." last="Waddington">J. L. Waddington</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Clinical Pharmacology, Royal College of Surgeons in Ireland</s1><s2>Dublin</s2><s3>IRL</s3><sZ>1 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>Dublin</wicri:noRegion></affiliation></author><author><name sortKey="Youssef, H A" sort="Youssef, H A" uniqKey="Youssef H" first="H. A." last="Youssef">H. A. Youssef</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>St Davnet's Hospital</s1><s2>Monaghan</s2><s3>IRL</s3><sZ>2 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>St Davnet's Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Kinsella, A" sort="Kinsella, A" uniqKey="Kinsella A" first="A." last="Kinsella">A. Kinsella</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Mathematics, Dublin Institute of Technology</s1><s3>IRL</s3><sZ>3 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>Department of Mathematics, Dublin Institute of Technology</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">British journal of psychiatry</title><title level="j" type="abbreviated">Br. j. psychiatry</title><idno type="ISSN">0007-1250</idno><imprint><date when="1998">1998</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">British journal of psychiatry</title><title level="j" type="abbreviated">Br. j. psychiatry</title><idno type="ISSN">0007-1250</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Chemotherapy</term><term>Drug combination</term><term>Epidemiology</term><term>Evolution</term><term>Follow up study</term><term>Human</term><term>Mortality</term><term>Neuroleptic</term><term>Parasympatholytic</term><term>Psychotropic</term><term>Risk factor</term><term>Schizophrenia</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Schizophrénie</term><term>Evolution</term><term>Mortalité</term><term>Facteur risque</term><term>Chimiothérapie</term><term>Traitement</term><term>Neuroleptique</term><term>Psychotrope</term><term>Association médicamenteuse</term><term>Parasympatholytique</term><term>Etude longitudinale</term><term>Epidémiologie</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Although increased mortality is one ofthe most consistent and accepted epidemiological findings in schizophrenia, a high rate ofsuicide appears unable to account fully for this burden which remains poorly understood. Method A cohort of 88 in-patients was followed prospectively over a 10-year period and predictors of survival sought among demographic, clinical and treatment variables. Results Over the decade, 39 of the 88 patients (44%) died, with no instances ofsuicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre-terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival : maximum number of antipsychotics given concurrently (relative risk 2.46, 95% Cl 1.10- 5.47; P=0.03) and absence of co-treatment with an anticholinergic (relative risk 3.33, 95% Cl 0.99-11.1; P=0.05). Conclusions Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use ofantipsychotic polypharmacy.Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation.</div></front></TEI><affiliations><list><country><li>Irlande (pays)</li></country></list><tree><country name="Irlande (pays)"><noRegion><name sortKey="Waddington, J L" sort="Waddington, J L" uniqKey="Waddington J" first="J. L." last="Waddington">J. L. Waddington</name></noRegion><name sortKey="Kinsella, A" sort="Kinsella, A" uniqKey="Kinsella A" first="A." last="Kinsella">A. Kinsella</name><name sortKey="Youssef, H A" sort="Youssef, H A" uniqKey="Youssef H" first="H. A." last="Youssef">H. A. Youssef</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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