Use of antipsychotic medication with weight-inducing potential in first-episode psychosis

Antipsychotic medication is recommended in the treatment of first-episode psychosis (FEP). Modern international guidelines do not recommend using antipsychotic medication with a high risk of weight-inducing potential (HWPA) as the first choice. However, many studies find the use of such antipsychotic medication in rates ranging from 30% to 60% among FEP patients, including in Norway. This study investigated the rates of HWPA use in FEP patients and possible demographic and clinical factors associated with its use.

This was a retrospective cohort study including all FEP patients treated at St. Olavs University Hospital from 2012 to 2016. Data regarding antipsychotic medication, demographic, and clinical variables were collected from the electronic records of all patients at treatment initiation and on use of medication at 1- and 2-year follow-up. Antipsychotic medications were categorized as HWPA or low/medium risk of weight-inducing potential (L/MWPA).

In total, 238 patients were included, of whom 123 (52%) were given HWPA as first medication, 83 patients (35%) were given L/MWPA, while 32 patients (13%) received no antipsychotic medication at treatment initiation. Higher age, acute referral, and severity of illness were associated with a higher risk of treatment with HWPA.

A large proportion of FEP patients in this cohort were initiated on HWPA as the first-choice medication. To ensure adherence to guidelines, there must be a focus on reducing the use of HWPA in FEP patients in general and in groups with a higher risk of being initiated on these antipsychotic medications.