Antipsychotic Medications and Risk of Acute Coronary Syndrome in Schizophrenia: A Nested Case-Control Study

<div><p>Background</p><p>This study assessed the risk of developing acute coronary syndrome requiring hospitalization in association with the use of certain antipsychotic medications in schizophrenia patients.</p><p>Methods</p><p>A nationwide cohort of 31,177 inpatients with schizophrenia between the ages of 18 and 65 years whose records were enrolled in the National Health Insurance Research Database in Taiwan from 2000 to 2008 and were studied after encrypting the identifications. Cases (n = 147) were patients with subsequent acute coronary syndrome requiring hospitalization after their first psychiatric admission. Based on a nested case-control design, each case was matched with 20 controls for age, sex and the year of first psychiatric admission using risk-set sampling. The effects of antipsychotic agents on the development of acute coronary syndrome were assessed using multiple conditional logistic regression and sensitivity analyses to confirm any association.</p><p>Results</p><p>We found that current use of aripiprazole (adjusted risk ratio [RR] = 3.68, 95% CI: 1.27–10.64, p<0.05) and chlorpromazine (adjusted RR = 2.96, 95% CI: 1.40–6.24, p<0.001) were associated with a dose-dependent increase in the risk of developing acute coronary syndrome. Although haloperidol was associated with an increased risk (adjusted RR = 2.03, 95% CI: 1.20–3.44, p<0.01), there was no clear dose-dependent relationship. These three antipsychotic agents were also associated with an increased risk in the first 30 days of use, and the risk decreased as the duration of therapy increased. Sensitivity analyses using propensity score-adjusted modeling showed that the results were similar to those of multiple regression analysis.</p><p>Conclusions</p><p>Patients with schizophrenia who received aripiprazole, chlorpromazine, or haloperidol could have a potentially elevated risk of developing acute coronary syndrome, particularly at the start of therapy.</p></div

Association between the current use of each second- or first-generation antipsychotic agent and the risk of acute coronary syndrome relative to the noncurrent use of antipsychotic agent (reference group).

<p>Association between the current use of each second- or first-generation antipsychotic agent and the risk of acute coronary syndrome relative to the noncurrent use of antipsychotic agent (reference group).</p

Duration of therapy and dose of individual antipsychotic agents by case patients with acute coronary syndrome and controls.

<p>Duration of therapy and dose of individual antipsychotic agents by case patients with acute coronary syndrome and controls.</p

Risk of acute coronary syndrome and effect of cumulative days of continuous antipsychotic treatment (no use as the reference group).

<p>Risk of acute coronary syndrome and effect of cumulative days of continuous antipsychotic treatment (no use as the reference group).</p

L'Écho : grand quotidien d'information du Centre Ouest

20 juin 19171917/06/20 (A46).Appartient à l’ensemble documentaire : PoitouCh

Construct Validity of the Chinese Version of the Activities of Daily Living Rating Scale III in Patients with Schizophrenia

<div><p>Background</p><p>The Chinese version of the Activities of Daily Living Rating Scale III (ADLRS-III), which has 10 domains, is commonly used for assessing activities of daily living (ADL) in patients with schizophrenia. However, construct validity (i.e., unidimensionality) for each domain of the ADLRS-III is unknown, limiting the explanations of the test results.</p><p>Purpose</p><p>This main purpose of this study was to examine unidimensionality of each domain in the ADLRS-III. We also examined internal consistency and ceiling/floor effects in patients with schizophrenia.</p><p>Methods</p><p>From occupational therapy records, we obtained 304 self-report data of the ADLRS-III. Confirmatory factor analysis (CFA) was conducted to examine the 10 one-factor structures. If a domain showed an insufficient model fit, exploratory factor analysis (EFA) was performed to investigate the factor structure and choose one factor representing the original construct. Internal consistency was examined using Cronbach’s alpha (α). Ceiling and floor effects were determined by the percentage of patients with the maximum and minimum scores in each domain, respectively.</p><p>Results</p><p>CFA analyses showed that 4 domains (i.e., leisure, picture recognition, literacy ability, communication tools use) had sufficient model fits. These 4 domains had acceptable internal consistency (α = 0.79-0.87) and no ceiling/floor effects, except the leisure domain which had a ceiling effect. The other 6 domains showed insufficient model fits. The EFA results showed that these 6 domains were two-factor structures.</p><p>Conclusion</p><p>The results supported unidimensional constructs of the leisure, picture recognition, literacy ability, and communication tool uses domains. The sum scores of these 4 domains can be used to represent their respective domain-specific functions. Regarding the 6 domains with insufficient model fits, we have explained the two factors of each domain and chosen one factor to represent its original construct. Future users may use the items from the chosen factors to assess domain-specific functions in patients with schizophrenia.</p></div

Factor loadings of the 6 domains with two-factor structure using exploratory factor analysis.

<p>Factor loadings of the 6 domains with two-factor structure using exploratory factor analysis.</p

Fit indices of the 10 domains of the ADLRS-III (n = 304).

<p>CFI = comparative fit index; TLI = Tucker-Lewis index; RMSEA = root mean square error of approximation; CI = confidence interval.</p><p>Fit indices of the 10 domains of the ADLRS-III (n = 304).</p

Estimates of difficulty, infit MNSQ, and outfit MNSQ in the final version of PEF.

<p>^aMean value of two thresholds.</p><p>Estimates of difficulty, infit MNSQ, and outfit MNSQ in the final version of PEF.</p

Item-person map.

<p>(A) volition; (B) planning; (C) purposive action; and (D) effective performance. The numbers after the decimal point for each item indicate the step difficulty. In a 3-point scale (0–2), for example, “diet control. 1” represents the first step difficulty (between response categories 0 and 1) of the “diet control” item and “diet control. 2” represents the second step difficulty (between response categories 1 and 2).</p