Association of Antipsychotic Treatment With Risk of Unexpected Death Among Children and Youths, Ray et al, JAMA Psychiatry, 2019

February 9, 2019

  • Children and youth 5-24 yo on Medicaid

  • New users of second generation antipsychotic medications (low-dose vs. high dose) for conditions other than psychotic disorders vs. controls using either ADHD meds, antidepressants, or non-antipsychotic mood stabilizers

    • 58,497 new users of antipsychotic medications

      • 28,377 low-dose (66% Risperdal)

      • 30,120 high-dose (34.3% Seroquel, 23.4% Abilify, 6.6% Zyprexa)

    • 189,361 new users of control meds

      • 42.9% ADHD meds (most frequently stimulants)

      • 49.6% antidepressants (most frequently SSRIs)

      • 7.5% mood stabilizers (most frequently anticonvulsants)

  • Person-years of follow-up

    • 123,005 in control group

    • 16,159 in low-dose antipsychotic group

    • 27,354 in high-dose antipsychotic group

  • Unexpected deaths

    • 67 (54.5 per 100,000 person-years) in the control group

      • 67.2% from injuries and deaths from suicides

    • 8 (49.5 per 100,000 person-years) in the low-dose antipsychotic group

    • 40 (146.2 per 100,000 person-years) in the high-dose antipsychotic group

  • Risk after adjustment for covariates

    • Risk of death in the high-dose antipsychotic group 80% greater than in the control group

      • The adjusted hazard ratio for unexpected deaths was 3.51, with 45 excess deaths per 100,000 person-years

      • Cardiovascular and metabolic risk the greatest

    • Risk of death from injury or suicide was not increased (hazard ratio of 1.03)

    • No increased risk of total mortality in low-dose antipsychotic group










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