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Association of Antipsychotic Treatment With Risk of Unexpected Death Among Children and Youths, Ray

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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