TY - JOUR
T1 - Effectiveness of Prescription-Based CNS Stimulants on Hospitalization in Patients With Schizophrenia
T2 - A Nation-Wide Register Study
AU - Rohde, Christopher
AU - Polcwiartek, Christoffer
AU - Asztalos, Marton
AU - Nielsen, Jimmi
N1 - © The Author(s) 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective: Negative symptoms and cognitive deficits are main features of schizophrenia but with limited treatment options. Earlier studies have suggested that central nervous system (CNS) stimulants have a small effect on these domains, but with inconclusive results. As the first study to date, we aimed to investigate whether CNS stimulants improve naturalistic outcomes (psychiatric admissions and antipsychotic use) in patients with schizophrenia. Methods: By using extensive health registers all patients with schizophrenia and their use of CNS stimulants in Denmark were identified. Two models were used to investigate the effectiveness of CNS stimulants in patients with schizophrenia between 1995 and 2014; a mirror-image model with 605 individuals, using paired t tests and Wilcoxon signed rank tests, and a follow-up study with 789 individuals, using a conditional risk-set model. Results: CNS stimulants use was associated with a reduction in number of psychiatric admissions from 3.43 (95% CI = 2.86 to 4.01) to 2.62 (95% CI = 1.99 to 3.25) (P =.009), with a more pronounced reduction for women (mean difference: ' '1.37, 95% CI = ' '2.34 to ' '0.40, P =.006). Psychiatric bed-days were reduced by 40 (95% CI = 24.5 to 55.6, P <.001) for individuals with at least 1 admission before CNS stimulant use. In addition, the total amount of antipsychotic use (Defined Daily Dose [DDD]) was reduced (P =.001). The Hazard rate ratio in psychiatric admissions between women taking CNS stimulants compared to women not taking CNS stimulants was 0.77 (95% CI = 0.67 to 0.88). Conclusion: CNS stimulants may have clinical potentials for improving functional outcomes in patients with schizophrenia and randomized clinical studies evaluating this topic are warranted.
AB - Objective: Negative symptoms and cognitive deficits are main features of schizophrenia but with limited treatment options. Earlier studies have suggested that central nervous system (CNS) stimulants have a small effect on these domains, but with inconclusive results. As the first study to date, we aimed to investigate whether CNS stimulants improve naturalistic outcomes (psychiatric admissions and antipsychotic use) in patients with schizophrenia. Methods: By using extensive health registers all patients with schizophrenia and their use of CNS stimulants in Denmark were identified. Two models were used to investigate the effectiveness of CNS stimulants in patients with schizophrenia between 1995 and 2014; a mirror-image model with 605 individuals, using paired t tests and Wilcoxon signed rank tests, and a follow-up study with 789 individuals, using a conditional risk-set model. Results: CNS stimulants use was associated with a reduction in number of psychiatric admissions from 3.43 (95% CI = 2.86 to 4.01) to 2.62 (95% CI = 1.99 to 3.25) (P =.009), with a more pronounced reduction for women (mean difference: ' '1.37, 95% CI = ' '2.34 to ' '0.40, P =.006). Psychiatric bed-days were reduced by 40 (95% CI = 24.5 to 55.6, P <.001) for individuals with at least 1 admission before CNS stimulant use. In addition, the total amount of antipsychotic use (Defined Daily Dose [DDD]) was reduced (P =.001). The Hazard rate ratio in psychiatric admissions between women taking CNS stimulants compared to women not taking CNS stimulants was 0.77 (95% CI = 0.67 to 0.88). Conclusion: CNS stimulants may have clinical potentials for improving functional outcomes in patients with schizophrenia and randomized clinical studies evaluating this topic are warranted.
KW - Journal Article
KW - ADHD
KW - methylphenidate
KW - psychiatric bed-days
KW - treatment effect
KW - negative symptoms
KW - antipsychotics
KW - psychiatric admissions
KW - cognitive dysfunction
KW - Follow-Up Studies
KW - Central Nervous System Stimulants/therapeutic use
KW - Comorbidity
KW - Humans
KW - Middle Aged
KW - Male
KW - Denmark/epidemiology
KW - Registries/statistics & numerical data
KW - Adult
KW - Female
KW - Hospitalization/statistics & numerical data
KW - Attention Deficit Disorder with Hyperactivity/drug therapy
KW - Schizophrenia/drug therapy
KW - Hospitals, Psychiatric/statistics & numerical data
KW - Outcome Assessment (Health Care)/statistics & numerical data
UR - http://www.scopus.com/inward/record.url?scp=85040833606&partnerID=8YFLogxK
U2 - 10.1093/schbul/sbx043
DO - 10.1093/schbul/sbx043
M3 - Journal article
C2 - 28379483
SN - 0586-7614
VL - 44
SP - 93
EP - 100
JO - Schizophrenia Bulletin
JF - Schizophrenia Bulletin
IS - 1
ER -