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Objective: Antipsychotics may increase serum prolactin, which has particularly been observed with risperidone. Further, hyperprolactinemia has been linked to osteoporosis-related fractures. Therefore, we investigated fracture risk in a nationwide cohort exposed to antipsychotics., Methods: Swedish registers were used to identify adults with two consecutive dispensations of risperidone (n = 38 211), other atypical antipsychotics not including paliperidone (n = 60 691), or typical antipsychotics (n = 17 445) within three months between 2006 and 2013. An osteoporosis-related fracture was defined as a non-open hip/femur fracture in primary analyses. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs)., Results: Risperidone users were on average older (mean age of 68, 44, and 63 years for risperidone, other atypical antipsychotics, and typical antipsychotics respectively). Compared with other atypical antipsychotics, there was no association between risperidone and osteoporosis-related fractures in the overall (HR = 1.04, CI: 0.91-1.19) or age-stratified analyses. A significantly increased risk of typical antipsychotics (HR = 1.24, CI: 1.07-1.45) compared with other atypical antipsychotics remained for ages >45 years., Conclusion: Risperidone does not appear to be associated with an increased risk of osteoporosis-related fracture compared with other atypical antipsychotic agents as a group. For typical antipsychotics, a moderately elevated risk of hip fractures was noted compared with other atypical antipsychotics, possibly because of residual confounding., (© 2019 The Authors. Acta Psychiatrica Scandinavica Published by John Wiley & Sons Ltd.)

Background: Several antipsychotics, especially risperidone, are known to increase serum prolactin. Hyperprolactinemia has been linked to the development of mammary gland tumors in animal studies. We therefore investigated the risk of breast cancer in a nationwide cohort of women using risperidone or other antipsychotics., Methods: All women, 18years or older, who initiated treatment with risperidone or any other antipsychotic between 2006 and 2012 were identified in Swedish nationwide registers. Patients with two consecutive dispensations of the same antipsychotic within 3months, no previous cancer diagnosis, and no previous dispensations of paliperidone were included. The final cohort consisted of 55976 women of whom 22908, 24524, and 8544 were exposed to risperidone, other atypical antipsychotics, and typical antipsychotics, respectively. A Cox regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between antipsychotics and breast cancer., Results: Patients were followed prospectively, the mean follow-up time ranging from 2.4 to 2.8years between treatment groups. After adjusting for age, there was no increased risk for breast cancer among risperidone users compared to patients exposed to another atypical antipsychotic (HR 0.94, 95% CI 0.72-1.22) or a typical antipsychotic (HR 1.25, 95% CI 0.94-1.66). Analyses stratified by tumor stage, using active treatment follow-up time, or including only treatment naïve patients did not reveal any noteworthy change in the results., Conclusion: Risperidone use does not confer an increased short-term risk of breast cancer compared to other antipsychotic agents., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: This study explores suicide risk in schizophrenia in relation to side effects from antipsychotic medication., Methods: Among patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4000), those who died by suicide within 5 years from diagnosis were defined as cases (n = 84; 54% male). For each case, one individually matched control was identified from the same population. Information on antipsychotic side effects, including extrapyramidal symptoms (EPS) and akathisia, as well as prescriptions of anticholinergic medication, was retrieved from clinical records in a blinded fashion. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of the association between suicide and side effects as well as anticholinergic medication were estimated using conditional logistic regression., Results: A lower suicide risk was found in patients with a history of EPS (aOR 0.33, 95% CI 0.12-0.94). There was no statistically significant association between akathisia or anticholinergic medication use and the suicide risk., Conclusions: A lower suicide risk identified among patients with EPS could potentially reflect higher antipsychotic adherence, exposure to higher dosage, or polypharmacy among these patients. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Introduction: Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of pharmacotherapy in relation to suicide risk is limited., Aim: To explore suicide risk in schizophrenia in relation to medication with antipsychotics, antidepressants, and lithium., Methods: Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n=4000), patients who died by suicide within five years from diagnosis were defined as cases (n=84; 54% male). Individually matched controls were identified from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Adjusted odds ratios [OR] of the association between medication and suicide were calculated by conditional logistic regression., Results: Lower suicide risk was found in patients who had been prescribed a second generation antipsychotic (clozapine, olanzapine, risperidone, or ziprasidone; 12 cases and 20 controls): OR 0.29 (95% confidence interval [CI], 0.09-0.97). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.23 (95% CI 0.06-0.89). No significant association was observed between suicide and prescription of any antipsychotic, depot injection antipsychotics, antidepressants, SSRI, or lithium., Conclusions: Lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these drugs, to differences in adherence, or to differences in other patient characteristics associated with lower suicide risk., (© 2013 Elsevier B.V. All rights reserved.)

Introduction: Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of how pharmacotherapy is related to suicide risk is limited. Aim: To explore suicide risk in relation to prescription of antipsychotics and antidepressants. Methods: Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n=4,000), patients who died by suicide within five years from diagnosis were defined as cases (n=84; 54% male). Individual matching was performed with schizophrenia controls from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Odds ratios (OR) of the association between medication and suicide risk were calculated by conditional logistic regression. Results: No significant association was observed between suicide and having ever been prescribed any antidepressant (33 cases and 30 controls) or any antipsychotic (83 cases and 82 controls). A lower suicide risk was found in patients who had ever been prescribed a second generation antipsychotic (risperidone, ziprazidone, olanzapine or clozapine; 12 cases and 23 controls): OR 0.2 (95% confidence interval [CI], 0.1–0.7). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.1 (95% CI, 0.03–0.6). Conclusions: The lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these medications, to differences in compliance, or to differences in other characteristics associated with a lower suicide risk. [ABSTRACT FROM AUTHOR]