We know that many people who take antipsychotic drugs find it difficult to cope with the side effects of the medication and this often leads to them stopping their treatment.

This large Finish cohort study examines the risks of rehospitalisation and drug discontinuation in patients recently diagnosed with schizophrenia who have been prescribed antipsychotics.

The study drew on data from national databases of hospitalisation, mortality, antipsychotic prescriptions and computed hazard ratios. The researchers adjusted for the effects of sociodemographic and clinical variables, the temporal sequence of the antipsychotics used, and the choice of the initial antipsychotic for each patient. 2,588 people were included in the study.

Here’s what they found:

• Only 58.2% collected a prescription for an antipsychotic during the first 30 days after hospital discharge
• 45.7% continued their initial treatment for 30 days or longer (95% confidence interval [CI]=43.7-47.6)
• The risk of rehospitalisation for patients receiving depot medications was about one-third of that for patients receiving oral medications (adjusted hazard ratio=0.36, 95% CI=0.17-0.75)
• Compared with oral risperidone, clozapine (adjusted hazard ratio=0.48, 95% CI=0.31-0.76) and olanzapine (adjusted hazard ratio=0.54, 95% CI=0.40-0.73) were each associated with a significantly lower rehospitalisation risk
• Use of any antipsychotic compared with no antipsychotic was associated with lower mortality (adjusted hazard ratio=0.45, 95% CI=0.31-0.67).

The authors concluded:

In Finland, only a minority of patients adhere to their initial antipsychotic during the first 60 days after discharge from their first hospitalization for schizophrenia. Use of depot antipsychotics was associated with a significantly lower risk of rehospitalization than use of oral formulations of the same compounds. Among oral antipsychotics, clozapine and olanzapine were associated with more favorable outcomes. Use of any antipsychotic was associated with lower mortality.

Tiihonen J, Haukka J, Taylor M, Haddad PM, Patel MX, Korhonen P. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011 Jun;168(6):603-9. Epub 2011 Mar 1. [PubMed abstract]