Odsbu I, Hamina A, Hjellvik V, Handal M, Haram M, Tesli M, Tanskanen A, Taipale H
Department of Chronic Diseases, The Norwegian Institute of Public Health, Oslo, Norway.
Niuvanniemi Hospital, Kuopio, Finland.
Acta Psychiatr Scand. 2025 Apr;151(4):537-547. doi: 10.1111/acps.13776. Epub 2024 Nov 29.
Antipsychotics are recommended after first-episode psychosis. Knowledge on the current use patterns in real-world settings is thus important to inform clinical practice. We aimed to describe antipsychotic initiation during 1 year after first-episode psychosis and its associated factors.
Population-based cohort study using linked nationwide health and population registers from Norway. The study population comprised 8052 persons aged 16-45 years with first-episode psychosis diagnosed in secondary care (ICD-10 F20, F22-F29) in the period 2011-2019. Initiation of antipsychotic use was defined as being dispensed antipsychotics (ATC N05A, excl. lithium) at least once from -90 to +365 days from secondary care diagnosis of first-episode psychosis. Antipsychotic polypharmacy during follow-up was defined as having at least 90 days with overlapping drug use periods modeled using the Prescriptions to Drug Use Periods method. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) for the association between socioeconomic and clinical factors and initiation of antipsychotic use were calculated using modified Poisson regression.
In total, 4413 persons (54.8%) initiated antipsychotic use after first-episode psychosis with proportions ranging from 45.5% in 2012 to 62.1% in 2019. Oral formulations of olanzapine (34.9%), quetiapine (21.2%), and aripiprazole (11.6%) were most common at initiation, whereas long-acting injectables (LAIs) and clozapine were rarely used. Among the initiators, 13.8% started a polypharmacy period lasting more than 90 days. Factors associated with antipsychotic initiation were lower age (aRR 1.14, 95% CI 1.08-1.21; 26-35 years vs. 36-45 years), higher education (1.11, 1.05-1.18), being employed (1.04, 1.00-1.09), being hospitalized (1.13, 1.09-1.18), being diagnosed late in the study period (1.16, 1.11-1.22; 2017-2019 vs. 2011-2013), or with previously diagnosed bipolar disorder, depression, or anxiety disorders.
The antipsychotic use pattern is largely within the current clinical guideline. Primary non-compliance and disease severity may explain the socioeconomic and clinical differences related to initiation of antipsychotic use.
首次发作精神病后推荐使用抗精神病药物。因此，了解现实环境中的当前使用模式对于指导临床实践很重要。我们旨在描述首次发作精神病后1年内抗精神病药物的起始使用情况及其相关因素。
基于人群的队列研究，使用来自挪威全国范围内的健康和人口登记数据链接。研究人群包括2011年至2019年期间在二级护理机构（国际疾病分类第十版F20、F22 - F29）诊断为首次发作精神病的8052名16 - 45岁的人。抗精神病药物使用的起始定义为从首次发作精神病的二级护理诊断起 - 90天至 + 365天内至少有一次配药（解剖学治疗学及化学分类系统N05A，不包括锂盐）。随访期间的抗精神病药物联合用药定义为使用处方到用药期方法建模的至少90天的重叠用药期。使用修正的泊松回归计算社会经济和临床因素与抗精神病药物起始使用之间关联的调整风险比（aRRs）及其95%置信区间（CIs）。
总共有4413人（54.8%）在首次发作精神病后开始使用抗精神病药物，比例从2012年的45.5%到2019年的62.1%不等。起始时最常用的口服制剂为奥氮平（34.9%）、喹硫平（21.2%）和阿立哌唑（11.6%），而长效注射剂（LAIs）和氯氮平很少使用。在起始使用者中，13.8%开始了持续超过90天的联合用药期。与抗精神病药物起始使用相关的因素包括年龄较小（aRR 1.14，95% CI 1.08 - 1.21；26 - 35岁与36 - 45岁相比）、受教育程度较高（1.11，1.05 - 1.18）、就业（1.04，1.00 - 1.09）、住院（1.13，1.09 - 1.18）、在研究期间较晚被诊断（1.16，1.11 - 1.22；2017 - 2019年与2011 - 2013年相比），或先前诊断为双相情感障碍、抑郁症或焦虑症。
抗精神病药物的使用模式在很大程度上符合当前临床指南。原发性不依从和疾病严重程度可能解释了与抗精神病药物起始使用相关的社会经济和临床差异。
