Antipsychotics heighten unexpected death risk in youth without psychosis

  • JAMA Psychiatry

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Children and young adults without psychosis receiving chlorpromazine-equivalent doses >50 mg have significantly increased risk for unexpected death.
  • These higher doses were specifically associated with increased risk for death from metabolic or cardiovascular (CV) causes.

Why this matters

  • Antipsychotics are used for many reasons among children beyond an indication for psychosis.
  • Editorial: The results “heighten the already increased caution about prescribing antipsychotics to children and adolescents.”

Key results

  • With higher antipsychotic dose vs control, unexpected deaths were 76.8 per 100,000 person-years vs 17.9 per 100,000 person-years.
  • Adjusted HRs (95% CIs) were:
    • All deaths: 1.80 (1.06-3.07).
    • Deaths from suicide or accidental injury: 1.03 (0.53-2.01).
    • Unexpected deaths: 3.51 (1.54-7.96).
    • Unexpected deaths from CV/metabolic causes: 4.29 (1.33-13.89).

Study design

  • Retrospective cohort study, Tennessee Medicaid enrollees, ages 5-24 years (30,120 high-dose group; 28,377 low-dose group; 189,361 controls [other types of medications]), 1999-2014, without severe somatic illness, schizophrenia/psychoses, Tourette, chronic tic disorder.
  • Outcome: death, including unexpected death from CV causes.
  • Funding: NIH.

Limitations

  • Possible uncontrolled confounding.
  • Patient factors such as BMI not known.

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