Il trattamento con antipsicotici e la mortalità dei pazienti ricoverati per schizofrenia e altri disturbi psicotici nella città di Torino

[Machine translation] Introduction. Antipsychotics are first-line medications for treating schizophrenia and other psychotic disorders. However, some clinical studies suggest that long-term exposure to first-generation (FGA), second-generation (SGA) antipsychotics, and combination therapy with antipsychotics may contribute to the excess early mortality of this type of patient. Objectives. The objective of the study is to evaluate the association between recent exposure to antipsychotics and the risk of death in a cohort of Turin patients hospitalized for psychotic disorders. Methods. The study population consists of 5,508 patients residing in Turin and hospitalized at least once between 1997 and 2010 for schizophrenia, paranoid disorder, and other non-organic psychoses as the primary cause of hospitalization. The information of interest was retrieved through record links between the SDO archive, the registry, the censuses, the mortality archive, and the pharmaceutical prescription archive. Each follow-up year was classified for each subject based on exposure to the specific treatment: every person who, according to the archive of pharmaceutical prescriptions, had purchased at least 3 boxes during the year was considered exposed to a certain antipsychotic in that year. The years of treatment were then classified as monotherapy, antipsychotic combination therapy and antipsychotic combination therapy and more if the patient in that year had purchased only one antipsychotic, 2 different antipsychotics, or one antipsychotic and another psychoactive drug. All those who did not fall into the treatment categories were classified as untreated. Monotherapy has been further classified into first-generation (FGA) or second-generation (SGA) antipsychotics. The association between exposure to treatment in the last year of follow-up and mortality was studied using an adjusted Poisson regression model. Results. Compared to untreated patients, patients exposed to monotherapy with FGA in the last year of follow-up showed a lower risk of death from natural causes (IRR 0.64; 95% CI: 0.41-1.00, p=0.048), while those with monotherapy with SGA and in combination therapy with antipsychotic and more were protected both against all-cause mortality (IRR 0.69; 95% CI: 0.50-0.94 and IRR 0.62; 95% CI: 0.60-0.83 respectively) and for natural causes (IRR 0.65; 95% CI: 0.46-0.83 respectively) 0.92 and IRR 0.53; 95% CI: 0.37-0.74 respectively). The mortality risk of patients receiving combination therapy with antipsychotics alone was not significantly different from that of the untreated. Conclusions. The results of the study are consistent with those of the large observational cohorts conducted in Northern Europe using social and health archives. Ensuring correct treatment strategies for psychotic patients must be a priority for the mental health care system.