University of Oulu

A.P. Hulkko, G.K. Murray, J. Moilanen, M. Haapea, I. Rannikko, P.B. Jones, J.H. Barnett, S. Huhtaniska, M.K. Isohanni, H. Koponen, E. Jääskeläinen, J. Miettunen, Lifetime use of psychiatric medications and cognition at 43years of age in schizophrenia in the Northern Finland Birth Cohort 1966, European Psychiatry, Volume 45, 2017, Pages 50-58, ISSN 0924-9338,

Lifetime use of psychiatric medications and cognition at 43 years of age in schizophrenia in the Northern Finland Birth Cohort 1966

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Author: Hulkko, Anja P.1,2,3; Murray, Graham K.4,5; Moilanen, Jani1,2,3;
Organizations: 1Department of Psychiatry, Research Unit of Clinical Neuroscience, P.O. Box 5000, 90014 University of Oulu, Finland
2Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
3Department of Psychiatry, Oulu University Hospital, P.O. Box 26, 90029 OYS, Oulu, Finland
4Department of Psychiatry, University of Cambridge, Box 189 Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom
5Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge CB2 0SZ, United Kingdom
6Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland
7Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, 90029 OYS, Finland
8Department of Psychiatry, University of Cambridge, Herchel Smith Building, Cambridge CB2 0SZ, United Kingdom
9Cambridge Cognition Ltd, Tunbridge Court, Bottisham, Cambridge, United Kingdom
10University of Helsinki and Helsinki University Hospital – Psychiatry, P.O. Box 22, 00014 Helsinki, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: Elsevier, 2017
Publish Date: 2019-11-27


Background: Higher lifetime antipsychotic exposure has been associated with poorer cognition in schizophrenia. The cognitive effects of adjunctive psychiatric medications and lifetime trends of antipsychotic use remain largely unclear. We aimed to study how lifetime and current benzodiazepine and antidepressant medications, lifetime trends of antipsychotic use and antipsychotic polypharmacy are associated with cognitive performance in midlife schizophrenia.

Methods: Sixty participants with DSM-IV schizophrenia from the Northern Finland Birth Cohort 1966 were examined at 43 years of age with an extensive cognitive test battery. Cumulative lifetime and current use of psychiatric medications were collected from medical records and interviews. The associations between medication and principal component analysis-based cognitive composite score were analysed using linear regression.

Results: Lifetime cumulative DDD years of benzodiazepine and antidepressant medications were not significantly associated with global cognition. Being without antipsychotic medication (for minimum 11 months) before the cognitive examination was associated with better cognitive performance (P = 0.007) and higher lifetime cumulative DDD years of antipsychotics with poorer cognition (P = 0.020), when adjusted for gender, onset age and lifetime hospital treatment days. Other lifetime trends of antipsychotic use, such as a long antipsychotic-free period earlier in the treatment history, and antipsychotic polypharmacy, were not significantly associated with cognition.

Conclusions: Based on these naturalistic data, low exposure to adjunctive benzodiazepine and antidepressant medications does not seem to affect cognition nor explain the possible negative effects of high dose long-term antipsychotic medication on cognition in schizophrenia.

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Series: European psychiatry
ISSN: 0924-9338
ISSN-E: 1778-3585
ISSN-L: 0924-9338
Volume: 45
Pages: 50 - 58
DOI: 10.1016/j.eurpsy.2017.06.004
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: This work was supported by the Academy of Finland [grant numbers 278 286, 268 336], the Sigrid Jusélius Foundation, the Brain & Behavior Research Foundation, the Jalmari and Rauha Ahokas Foundation, the Finnish Cultural Foundation Lapland Regional Fund, the Northern Finland Health Care Support Foundation, the scholarship Fund of the University of Oulu - Tyyni Tani Fund, the Foundation for Psychiatric Research and the Orion Research Foundation sr. J.H.B. was an employee of Cambridge Cognition. The funding bodies had no further role in study design; in the collection, management, analysis and interpretation of data; in the preparation, review or approval of the manuscript; or in the decision to submit the paper for publication.
Academy of Finland Grant Number: 278286
Detailed Information: 278286 (Academy of Finland Funding decision)
268336 (Academy of Finland Funding decision)
Copyright information: © 2017 The Authors. Published by Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license