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Published on: November 21, 2013
Initiation of Antipsychotics During the First Year After First-Episode Psychosis: A Population-Based Study
I Odsbu1, A Hamina2, V Hjellvik1
1Department of Chronic Diseases, The Norwegian Institute of Public Health, Oslo, Norway.
Insights
Over half of first-episode psychosis patients initiated antipsychotic treatment within a year, with oral medications most common. Socioeconomic and clinical factors influenced initiation, suggesting potential non-compliance or disease severity issues.
Area of Science:
- Psychiatry
- Pharmacology
- Public Health
Background:
- Antipsychotic medication is recommended for patients experiencing their first episode of psychosis.
- Understanding real-world antipsychotic use patterns is crucial for refining clinical practice.
- This study investigates antipsychotic initiation and associated factors in first-episode psychosis patients.
Purpose of the Study:
- To describe the patterns of antipsychotic initiation within one year following a first-episode psychosis diagnosis.
- To identify socioeconomic and clinical factors associated with antipsychotic initiation in this population.
Main Methods:
- A population-based cohort study utilized linked nationwide health and population registers in Norway.
- Included 8052 individuals aged 16-45 years diagnosed with first-episode psychosis (ICD-10 F20, F22-F29) between 2011-2019.
- Antipsychotic initiation was defined by dispensing records within 365 days post-diagnosis; modified Poisson regression analyzed associated factors.
Main Results:
- 54.8% of patients initiated antipsychotic use, with initiation rates increasing from 45.5% (2012) to 62.1% (2019).
- Oral olanzapine, quetiapine, and aripiprazole were the most common initiators; long-acting injectables and clozapine were rarely used.
- Lower age, higher education, employment, hospitalization, later diagnosis, and comorbid mood/anxiety disorders were associated with initiation.
Conclusions:
- Antipsychotic prescribing patterns generally align with clinical guidelines.
- Observed socioeconomic and clinical differences in initiation may be linked to primary non-compliance or disease severity.
Background:
Antipsychotics are recommended after first-episode psychosis. Knowledge on the current use patterns in real-world settings is thus important to inform clinical practice. We aimed to describe antipsychotic initiation during 1 year after first-episode psychosis and its associated factors.
Methods:
Population-based cohort study using linked nationwide health and population registers from Norway. The study population comprised 8052 persons aged 16-45 years with first-episode psychosis diagnosed in secondary care (ICD-10 F20, F22-F29) in the period 2011-2019. Initiation of antipsychotic use was defined as being dispensed antipsychotics (ATC N05A, excl. lithium) at least once from -90 to +365 days from secondary care diagnosis of first-episode psychosis. Antipsychotic polypharmacy during follow-up was defined as having at least 90 days with overlapping drug use periods modeled using the Prescriptions to Drug Use Periods method. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for the association between socioeconomic and clinical factors and initiation of antipsychotic use were calculated using modified Poisson regression.
Results:
In total, 4413 persons (54.8%) initiated antipsychotic use after first-episode psychosis with proportions ranging from 45.5% in 2012 to 62.1% in 2019. Oral formulations of olanzapine (34.9%), quetiapine (21.2%), and aripiprazole (11.6%) were most common at initiation, whereas long-acting injectables (LAIs) and clozapine were rarely used. Among the initiators, 13.8% started a polypharmacy period lasting more than 90 days. Factors associated with antipsychotic initiation were lower age (aRR 1.14, 95% CI 1.08-1.21; 26-35 years vs. 36-45 years), higher education (1.11, 1.05-1.18), being employed (1.04, 1.00-1.09), being hospitalized (1.13, 1.09-1.18), being diagnosed late in the study period (1.16, 1.11-1.22; 2017-2019 vs. 2011-2013), or with previously diagnosed bipolar disorder, depression, or anxiety disorders.
Conclusions:
The antipsychotic use pattern is largely within the current clinical guideline. Primary non-compliance and disease severity may explain the socioeconomic and clinical differences related to initiation of antipsychotic use.
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