#Antipsychotic Use in Pregnancy and the Risk for Congenital #Malformations
http://archpsyc.jamanetwork.com/mobile/article.aspx?articleid=2545072
Conclusions and Relevance Evidence from this large study suggests that use of APs early in pregnancy generally does not meaningfully increase the risk for congenital malformations overall or cardiac malformations in particular. The small increase in the risk for malformations observed with risperidone requires additional study.
http://archpsyc.jamanetwork.com/mobile/article.aspx?articleid=2545072
Conclusions and Relevance Evidence from this large study suggests that use of APs early in pregnancy generally does not meaningfully increase the risk for congenital malformations overall or cardiac malformations in particular. The small increase in the risk for malformations observed with risperidone requires additional study.
Jamanetwork
Use of Antipsychotics in Pregnancy
This pharmacoepidemiology study examines associations between first-trimester antipsychotic exposure and risk for overall congenital and cardiac malformations among children born to women enrolled in Medicaid.
#Antipsychotic use and risk of hospitalisation or death due to #pneumonia in persons with and without Alzheimer’s disease
http://journal.publications.chestnet.org/mobile/article.aspx?articleid=2529123
Conclusions Regardless of applied study design, treatment duration, or the choice of drug, antipsychotic use was associated with higher risk of pneumonia. With observational data we cannot fully rule out a shared causality between pneumonia and antipsychotic use, but the risk-benefit balance should be considered when antipsychotics are prescribed.
http://journal.publications.chestnet.org/mobile/article.aspx?articleid=2529123
Conclusions Regardless of applied study design, treatment duration, or the choice of drug, antipsychotic use was associated with higher risk of pneumonia. With observational data we cannot fully rule out a shared causality between pneumonia and antipsychotic use, but the risk-benefit balance should be considered when antipsychotics are prescribed.
journal.publications.chestnet.org
Antipsychotic use and risk of hospitalisation or death due to pneumonia in persons with and without Alzheimer’s disease
Background
Antipsychotics have been associated with increased pneumonia risk, but although persons with dementia are particularly susceptible to pneumonia, only one small study assessed the risk of pneumonia in relation to antipsychotic use among persons…
Antipsychotics have been associated with increased pneumonia risk, but although persons with dementia are particularly susceptible to pneumonia, only one small study assessed the risk of pneumonia in relation to antipsychotic use among persons…
Association Between #Antipsychotic Agents and Risk of Acute #Respiratory Failure in Patients With Chronic Obstructive Pulmonary Disease
http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2595040
These findings suggest an acute risk of ARF from antipsychotic use in patients with chronic obstructive pulmonary disease, and future studies are required to confirm the observed association.
http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2595040
These findings suggest an acute risk of ARF from antipsychotic use in patients with chronic obstructive pulmonary disease, and future studies are required to confirm the observed association.
Jamanetwork
Antipsychotic Agents and Risk of Acute Respiratory Failure in COPD
This population-based case-crossover study uses the Taiwan National Health Insurance Research Database to determine whether the use of antipsychotics is associated with an increased risk of acute respiratory failure in patients with chronic obstructive pulmonary…
#Antipsychotic drugs for the acute treatment of patients with a first episode of #schizophrenia: a systematic review with pairwise and network meta-analyses
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30270-5/abstract
The first episode of schizophrenia is a pivotal phase of this debilitating illness. Which drug to use remains controversial without a summary of all direct or indirect comparisons of drugs. We did a systematic review with pairwise and network meta-analyses of efficacy and tolerability. For overall reduction of symptoms, amisulpride (SMD −0·37, 95% CI −0·61 to −0·14), olanzapine (−0·25, −0·39 to −0·12), ziprasidone (−0·25, −0·48 to −0·01), and risperidone (−0·14, −0·27 to −0·01) were significantly more efficacious than haloperidol, but the evidence was very low to moderate quality. Amisulpride was superior for reduction of symptoms to quetiapine (SMD −0·25, 95% CI −0·50 to −0·01). Olanzapine was superior to haloperidol and risperidone for reduction of negative symptoms.
Haloperidol seems to be a suboptimum treatment option for acute treatment of first-episode schizophrenia, but we found little difference between second-generation antipsychotics. The evidence was generally of low quality and the numbers of patients for each drug were small. Thus, the choice of treatment should be guided primarily by side-effects
http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30270-5/abstract
The first episode of schizophrenia is a pivotal phase of this debilitating illness. Which drug to use remains controversial without a summary of all direct or indirect comparisons of drugs. We did a systematic review with pairwise and network meta-analyses of efficacy and tolerability. For overall reduction of symptoms, amisulpride (SMD −0·37, 95% CI −0·61 to −0·14), olanzapine (−0·25, −0·39 to −0·12), ziprasidone (−0·25, −0·48 to −0·01), and risperidone (−0·14, −0·27 to −0·01) were significantly more efficacious than haloperidol, but the evidence was very low to moderate quality. Amisulpride was superior for reduction of symptoms to quetiapine (SMD −0·25, 95% CI −0·50 to −0·01). Olanzapine was superior to haloperidol and risperidone for reduction of negative symptoms.
Haloperidol seems to be a suboptimum treatment option for acute treatment of first-episode schizophrenia, but we found little difference between second-generation antipsychotics. The evidence was generally of low quality and the numbers of patients for each drug were small. Thus, the choice of treatment should be guided primarily by side-effects
Long-Term #Antipsychotic Use and Major #Cardiovascular Events: A Retrospective Cohort Study
http://www.psychiatrist.com/jcp/article/Pages/2017/v78n08/16m10976.aspx
A retrospective cohort study was conducted in adult outpatients aged 30 years or older initiating antipsychotic treatment from 2002 to 2007.
Antipsychotic medications were divided into 3 groups (low-, intermediate-, and high-risk) according to the severity of their side-effect profiles in developing metabolic abnormalities associated with cardiovascular disease. The primary outcome measure was the time to the composite of acute myocardial infarction, acute coronary syndrome, ischemic stroke, peripheral artery disease, or a new revascularization procedure.
Inverse probability weighting of a marginal structural Cox model was used to adjust for confounding Older adult patients under antipsychotic regimens with high or intermediate risk of metabolic side effects may face a higher incidence of major cardiovascular events than those under a low-risk regimen during long-term follow-up
http://www.psychiatrist.com/jcp/article/Pages/2017/v78n08/16m10976.aspx
A retrospective cohort study was conducted in adult outpatients aged 30 years or older initiating antipsychotic treatment from 2002 to 2007.
Antipsychotic medications were divided into 3 groups (low-, intermediate-, and high-risk) according to the severity of their side-effect profiles in developing metabolic abnormalities associated with cardiovascular disease. The primary outcome measure was the time to the composite of acute myocardial infarction, acute coronary syndrome, ischemic stroke, peripheral artery disease, or a new revascularization procedure.
Inverse probability weighting of a marginal structural Cox model was used to adjust for confounding Older adult patients under antipsychotic regimens with high or intermediate risk of metabolic side effects may face a higher incidence of major cardiovascular events than those under a low-risk regimen during long-term follow-up
Psychiatrist
J Clin Psychiatry/Long-Term Antipsychotic Use and Major Cardiovascular Events: A Retrospective Cohort Study
Does your patient who is at high risk of cardiovascular disease need antipsychotic treatment? Read this article for insight on which antipsychotic medications have the lowest incidence of major cardiovascular events.
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#Antipsychotic treatment of very late-onset schizophrenia-like #psychosis (ATLAS): a randomised, controlled, double-blind trial
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30141-X/fulltext
..Fewer participants who were allocated amisulpride than placebo stopped treatment because of non-efficacy in stage 1 (p=0·010) and stage 2 (p=0·031). Serious adverse events were reported more frequently in the amisulpride group than in the placebo group in stage 1 (p=0·057) and stage 2 (p=0·19). The most common serious adverse events were infection (five patients in the amisulpride group, three in the placebo group) and extrapyrimidal side-effects (three patients in the amisulpride group, none in the placebo group). Five patients died during the study, one from a gastric ulcer bleed before treatment started (group B), two while taking stage 2 treatment (one in group A and one in group C), and two who stopped trial treatment in stage 1 and died many weeks later (one in group B and one in group C). No deaths were related to treatment.
Interpretation
Low-dose amisulpride is effective and well tolerated as a treatment for very late-onset schizophrenia-like psychosis, with benefits maintained by prolonging treatment.
#Antipsychotic treatment of very late-onset schizophrenia-like #psychosis (ATLAS): a randomised, controlled, double-blind trial
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30141-X/fulltext
..Fewer participants who were allocated amisulpride than placebo stopped treatment because of non-efficacy in stage 1 (p=0·010) and stage 2 (p=0·031). Serious adverse events were reported more frequently in the amisulpride group than in the placebo group in stage 1 (p=0·057) and stage 2 (p=0·19). The most common serious adverse events were infection (five patients in the amisulpride group, three in the placebo group) and extrapyrimidal side-effects (three patients in the amisulpride group, none in the placebo group). Five patients died during the study, one from a gastric ulcer bleed before treatment started (group B), two while taking stage 2 treatment (one in group A and one in group C), and two who stopped trial treatment in stage 1 and died many weeks later (one in group B and one in group C). No deaths were related to treatment.
Interpretation
Low-dose amisulpride is effective and well tolerated as a treatment for very late-onset schizophrenia-like psychosis, with benefits maintained by prolonging treatment.
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Second-generation #antipsychotic drugs and short-term #mortality: a systematic review and meta-analysis of placebo-controlled randomised controlled trials
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30177-9/fulltext
We found no evidence of a difference between antipsychotic drugs and placebo in mortality by any cause (OR 1·19; 95% CI 0·93–1·53), from natural causes (1·29; 0·85–1·94), from suicide (1·15; 0·47–2·81), and from other non-natural causes (1·55; 0·66–3·63). Most subgroup and meta-regression analyses did not indicate any important effect moderators. The exceptions were increased mortality in patients with dementia (OR 1·56; 95% CI 1·10–2·21), in elderly patients (1·38; 1·01–1·89), in aripiprazole-treated patients (2·20; 1·00–4·86), and in studies with a higher proportion of women (regression coefficient 0·025; 95% credible interval 0·010–0·040). However, the effects in elderly patients, aripiprazole-treated patients, and women were mainly based on the included dementia trials. For patients with schizophrenia there was no evidence of an increased mortality risk (OR 0·69; 95% CI 0·35–1·35).
Interpretation
Overall, and for the main indication of schizophrenia, there is no evidence from randomised trials that antipsychotic drugs increase mortality. However, vulnerable populations (particularly patients with dementia) might be at increased risk. This meta-analysis could only address acute treatment effects leading to death in the short-term, and not long-term effects of antipsychotic drugs on mortality.
Second-generation #antipsychotic drugs and short-term #mortality: a systematic review and meta-analysis of placebo-controlled randomised controlled trials
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30177-9/fulltext
We found no evidence of a difference between antipsychotic drugs and placebo in mortality by any cause (OR 1·19; 95% CI 0·93–1·53), from natural causes (1·29; 0·85–1·94), from suicide (1·15; 0·47–2·81), and from other non-natural causes (1·55; 0·66–3·63). Most subgroup and meta-regression analyses did not indicate any important effect moderators. The exceptions were increased mortality in patients with dementia (OR 1·56; 95% CI 1·10–2·21), in elderly patients (1·38; 1·01–1·89), in aripiprazole-treated patients (2·20; 1·00–4·86), and in studies with a higher proportion of women (regression coefficient 0·025; 95% credible interval 0·010–0·040). However, the effects in elderly patients, aripiprazole-treated patients, and women were mainly based on the included dementia trials. For patients with schizophrenia there was no evidence of an increased mortality risk (OR 0·69; 95% CI 0·35–1·35).
Interpretation
Overall, and for the main indication of schizophrenia, there is no evidence from randomised trials that antipsychotic drugs increase mortality. However, vulnerable populations (particularly patients with dementia) might be at increased risk. This meta-analysis could only address acute treatment effects leading to death in the short-term, and not long-term effects of antipsychotic drugs on mortality.
Mortality risk of #antipsychotic augmentation for adult depression
https://2medical.news/2020/11/01/mortality-risk-of-antipsychotic-augmentation-for-adult-depression/
Randomized controlled trials have demonstrated increased all-cause mortality in elderly patients with dementia treated with newer antipsychotics. It is unknown whether this risk generalizes to non-elderly adults using newer antipsychotics as augmentation treatment for depression.. ..Non-elderly adults (25–64 years) diagnosed with depression who after ≥3 months of antidepressant monotherapy initiated either augmentation with a newer antipsychotic or with a second antidepressant. Patients with alternative indications …
https://2medical.news/2020/11/01/mortality-risk-of-antipsychotic-augmentation-for-adult-depression/
Randomized controlled trials have demonstrated increased all-cause mortality in elderly patients with dementia treated with newer antipsychotics. It is unknown whether this risk generalizes to non-elderly adults using newer antipsychotics as augmentation treatment for depression.. ..Non-elderly adults (25–64 years) diagnosed with depression who after ≥3 months of antidepressant monotherapy initiated either augmentation with a newer antipsychotic or with a second antidepressant. Patients with alternative indications …
Lower risk of #SARS-CoV2 infection in individuals with severe #mental disorders on #antipsychotic treatment: A retrospective epidemiological study in a representative Spanish population
https://2medical.news/2021/04/20/lower-risk-of-sars-cov2-infection-in-individuals-with-severe-mental-disorders-on-antipsychotic-treatment-a-retrospective-epidemiological-study-in-a-representative-spanish-population/
To the editors, The population with severe mental disorders (SMD) is a medically and socially vulnerable group for a worse outcome in COVID-19. This population has been identified as high-risk group for COVID-19 due to lower awareness of risk, higher prevalence of cognitive impairment and who have limitations to maintain adequate barriers against virus propagation such as living in long-term care facilities, and people with …
https://2medical.news/2021/04/20/lower-risk-of-sars-cov2-infection-in-individuals-with-severe-mental-disorders-on-antipsychotic-treatment-a-retrospective-epidemiological-study-in-a-representative-spanish-population/
To the editors, The population with severe mental disorders (SMD) is a medically and socially vulnerable group for a worse outcome in COVID-19. This population has been identified as high-risk group for COVID-19 due to lower awareness of risk, higher prevalence of cognitive impairment and who have limitations to maintain adequate barriers against virus propagation such as living in long-term care facilities, and people with …