Antipsychotics and Their Association With Long-Term Outcomes in Young Ischemic Stroke Patients

Area of Science:

• Neurology
• Psychiatry
• Pharmacology

Background:

• Psychotic disorders and antipsychotic use may negatively impact outcomes after ischemic stroke (IS).
• Limited data exists on antipsychotic use patterns and outcomes specifically in young IS patients.
• This study investigates antipsychotic use in young IS patients before and after stroke.

Purpose of the Study:

• To characterize young patients purchasing antipsychotics prior to IS or de novo post-stroke.
• To examine the association between pre-stroke and post-stroke antipsychotic use and long-term outcomes.

Main Methods:

• Analysis of the Helsinki Young Stroke Registry (1008 patients aged 15-49 with first-ever IS).
• Categorization into non-users, prior users (pre-IS purchases), and de novo users (post-IS purchases).
• Cox regression models used to assess associations with recurrent vascular events or all-cause mortality.

Main Results:

• 5.7% of young IS survivors purchased antipsychotics before stroke; 6.9% initiated them after.
• Prior users exhibited more risk factors (psychiatric history, substance abuse, smoking, heavy drinking) and severe stroke symptoms.
• Pre-stroke antipsychotic use was associated with increased hazard of endpoint events (vascular events or mortality), adjusted for confounders.

Conclusions:

• Approximately 6% of young IS patients had prior antipsychotic use, with a similar proportion initiating use post-stroke.
• Pre-stroke antipsychotic use is a significant predictor of recurrent vascular events and mortality in young IS patients.
• De novo post-stroke antipsychotic use was not associated with adverse long-term outcomes.