University of Oulu

Tomi Bergström, Jyri J Taskila, Birgitta Alakare, Päivi Köngäs-Saviaro, Jouko Miettunen, Jaakko Seikkula, Five-Year Cumulative Exposure to Antipsychotic Medication After First-Episode Psychosis and its Association With 19-Year Outcomes, Schizophrenia Bulletin Open, Volume 1, Issue 1, January 2020, sgaa050,

Five-year cumulative exposure to antipsychotic medication after first-episode psychosis and its association with 19-year outcomes

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Author: Bergström, Tomi1,2; Taskila, Jyri J.1; Alakare, Birgitta1;
Organizations: 1Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland
2Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
3Center for Life Course Health Research, University of Oulu, Oulu, Finland
4Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: Oxford University Press, 2020
Publish Date: 2021-08-26


Background: The long-term effectiveness of antipsychotic maintenance treatment after first-episode psychosis (FEP) is contested. In this real-world observational study, we examined how cumulative exposure to antipsychotics within the first 5 years from FEP was associated with the 19-year outcome.

Methods: Finnish national registers were used to detect all patients who were hospitalized due to non-affective psychosis in the mid-1990s, and who were treatment naïve prior to the inclusion period (N = 1318). Generalized linear models with logit link function were used to estimate how cumulative exposure to antipsychotics within the first 5 years from onset was associated with mortality, work capability, and the use of psychiatric services at the end of the 19-year follow-up. To adjust for confounding by indication, the primary outcome analyses implemented stabilized inverse probability of treatment weighting using propensity scores.

Results: Persons with a higher cumulative exposure to antipsychotics within the first 5 years from FEP were more likely to still be receiving antipsychotics (adjusted odds ratio [OR] = 2.1; 95% CI: 1.5−2.8), psychiatric treatment (OR = 1.4; 95% CI: 1.1−1.7), and disability allowances (OR = 1.3; 95% CI: 1.01−1.6) at the end of the 19-year follow-up, as compared to low/zero-exposure. Higher cumulative exposure was also associated with higher mortality (OR = 1.5; 95% CI: 1.1–2.1).

Conclusions: After adjustment for confounders, moderate and high cumulative exposure to antipsychotics within the first 5 years from FEP was consistently associated with a higher risk of adverse outcomes during the 19-year follow-up, as compared to low or zero exposure. Due to potential unmeasured confounding, controlled trials are needed.

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Series: Schizophrenia bulletin open
ISSN: 2632-7899
ISSN-E: 2632-7899
ISSN-L: 2632-7899
Volume: 1
Issue: 1
Pages: 1 - 8
DOI: 10.1093/schizbullopen/sgaa050
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: Supported in part by Finnish State Research Funding (VTR), granted by the Ministry of Social Affairs and Health, Finland. The funding source had no involvement in the design, collection, analysis, or interpretation of the data.
Copyright information: © The Author(s) 2020. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact