ANTIPSYCHOTICS AND MORTALITY IN PATIENTS AND ELDERLY PATIENTS WITH SCHIZOPHRENIA: A NATIONWIDE COHORT STUDY IN TAIWAN

Abstract Background Patients with schizophrenia had higher mortality rates, experiencing a 15-year reduction in life expectancy in Taiwan compared to the general population [1]. The causes of excess mortality were multifaceted, and the role of antipsychotic medications in mortality remained inconclusive. Additionally, as the population continued to age gradually, elderly schizophrenia was a population that required much attention. Aims & Objectives We aimed to investigate excess mortality in schizophrenia patients based on cumulative antipsychotic exposure and explore medication dosage associations with mortality in the adult and elderly schizophrenia population. Method This population-based cohort study examined patients with schizophrenia using Taiwan’ s national health insurance database. The cohort included individuals aged 15 years or older diagnosed with schizophrenia in 2010, followed for five years (2010–2014). A subgroup of elderly patients was also studied. Mortality in schizophrenia patients was compared to an age- and gender- matched control sample. Cox regression models assessed overall and cardiovascular mortality based on different antipsychotic exposure levels, using two models: one adjusted solely for age and sex, and the other adjusted for covariates including demographic, socioeconomic data, and comorbid physical illnesses. Results We examined 102,964 patients with schizophrenia, including 6,433 elderly patients. In comparison to age- and gender-matched controls, schizophrenia patients with no antipsychotic exposure exhibited the highest overall mortality risk and cardiovascular mortality, followed by high exposure, low exposure and moderate exposure groups. A similar pattern was observed in elderly schizophrenia patients, but high antipsychotic exposure associated with the highest risk in both overall and cardiovascular mortality in elderly patients. Discussion & Conclusions Use of antipsychotics is beneficial to patients with schizophrenia, with the most recommended antipsychotic exposure range from low to moderate exposure. Overall, antipsychotic exposure showed a U-shaped pattern in both overall and cardiovascular mortality for patients with schizophrenia and elderly schizophrenia patients, respectively. In elderly patients, high antipsychotic exposure was associated with the highest mortality risk, contrasting with all patients with schizophrenia. References [1]Pan, Y.-J., Yeh, L.-L., Chan, H.-Y. and Chang, C.-K. (2020). Excess mortality and shortened life expectancy in people with major mental illnesses in Taiwan. Epidemiology and psychiatric sciences, 29, p.e156.