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Antipsychotic Use & Risk of Work Disability in First-Episode Nonaffective Psychosis

Antipsychotic agents, particularly those in long-acting formulations, are associated with a 30% to 50% reduced risk of work disability, a within-subject study shows, compared with nonuse of the agents. The reduced risk “held true beyond 5 years after first diagnosis,” the authors write. “These findings are informative regarding the important topic of early discontinuation of antipsychotic treatment after a first episode of nonaffective psychosis, but they need replication.”

The risk of sickness absence or disability pension was studied in a nationwide cohort of 21,551 patients with first-episode nonaffective psychosis in Sweden. “Overall, 45.9% of first-episode patients had work disability during the median length of follow-up of 4.8 years,” report the investigators. “The risk of work disability was lower during use compared with nonuse of any antipsychotic (adjusted hazard ratio [aHR]=0.65, 95% CI=0.59–0.72). The lowest adjusted hazard ratios emerged for long-acting injectable antipsychotics (aHR=0.46, 95% CI=0.34–0.62), oral aripiprazole (aHR=0.68, 95% CI=0.56–0.82), and oral olanzapine (aHR=0.68, 95% CI=0.59–0.78). Long-acting injectables were associated with lower risk than olanzapine, the most commonly used oral antipsychotic (aHR=0.68, 95% CI=0.50–0.94). Adjusted hazard ratios were similar during the periods of <2 years, 2–5 years, and >5 years since diagnosis.”

Source: American Journal of Psychiatry