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Study: Antipsychotic Drugs Improve Life Expectancy in Schizophrenia Patients

Mental health providers play crucial role in patient survival (Nov. 1)

Results of a Johns Hopkins study suggest that individuals with schizophrenia are significantly more likely to live longer if they take their antipsychotic drugs on schedule, avoid extremely high doses, and regularly see a mental health professional.

Researchers analyzed data collected between 1994 and 2004 from 2,132 adult Maryland Medicaid beneficiaries with schizophrenia. The researchers reviewed how much medication the patients took, how regularly they took it, and how often they visited a mental health professional. The goal of the study was to review how adherence to the 2009 pharmacological Schizophrenia Patient Outcomes Research Team (PORT) guidelines was associated with mortality in this population.

Comparing data from year to year, the researchers found that among the patients who had 90% or better compliance with their medication schedules, the risk of death was 25% lower compared with those who were less than 10% compliant. Over the decade-long study period, taking medications did not increase the risk of death, and there was a trend towards reducing the mortality rate. In addition, the researchers found that each additional visit per year to a mental health professional was linked to a 5% reduction in the overall risk of death.

The researchers did not rule out all links between increased mortality and antipsychotic drugs. For example, they found that people who took high doses of first-generation antipsychotic medications daily (1,500 mg or greater chlorpromazine equivalents) were 88% more likely to die. According to study leader Dr. Bernadette Cullen, mortality rates probably increased in this group because first-generation antipsychotics have been associated with cardiac disease risks, and among those who died while taking the larger doses, 53% died of cardiovascular disease.

Among the patients whose information was reviewed, the most common cause of death was cardiovascular disease (28%); unintended harm, including suicide, was responsible for 8% of deaths.

“If people are taking their medications, they usually have fewer symptoms and are able to be more organized in other areas of their lives,” Cullen said. “We believe they are then more likely to make appointments with their primary care doctors, to stay on top of other illnesses they may have, and to regularly take diabetes, blood pressure, or cholesterol medication that they may require to stay healthy. We also believe that they are more likely to be socially engaged and have a healthier lifestyle.”

Cullen said that the study clearly lays out the value of mental health providers to individuals with schizophrenia. Those who saw therapists or psychiatrists were more likely to survive, regardless of whether the individual also took his or her antipsychotic medication on a regular basis, she said.

Cullen noted that adherence to a medication regimen and moderate first-generation antipsychotic dosing are both part of the 2009 PORT recommendations designed to guide treatment.

The study findings were published in Schizophrenia Bulletin.

Source: Johns Hopkins Medicine, November 1, 2012.

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