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題名 Antipsychotic medications and stroke in schizophrenia: A case-crossover study 作者 Chen, Wen-Yin
Chen, Lian-Yu
Liu, Hsing-Cheng
Wu, Chi-Shin
Yang, Shu-Yu
Pan, Chun-Hung
Tsai, Shang-Ying
Chen, Chiao-Chicy
Kuo, Chian-Jue貢獻者 心理系 日期 2017-06 上傳時間 27-Jul-2017 12:44:06 (UTC+8) 摘要 Background: The association between antipsychotic use and the risk of stroke in schizophrenic patients is controversial. We sought to study the association in a nationwide cohort with schizophrenia. Methods: Using a retrospective cohort of patients with schizophrenia (N = 31,976) derived from the Taiwan National Health Insurance Research Database, 802 new-onset cases of stroke were identified within 10 years of follow-up (from 2000 through 2010). We designed a casecrossover study using 14-day windows to explore the risk factors of stroke and the association between antipsychotic drugs and the risk of stroke. We analyzed the risks of individual antipsychotics on various subgroups of stroke including ischemic, hemorrhagic, and other strokes, and the risks based on the antipsychotic receptor-binding profile of each drug. Results: Use of any second-generation antipsychotic was associated with an increased risk of stroke (adjusted risk ratio = 1.45, P = .009) within 14 days while the use of any first-generation antipsychotic was not. Intriguingly, the use of any second-generation antipsychotic was associated with ischemic stroke but not hemorrhagic stroke. The antipsychotic receptor-binding profile analysis showed that the antihistamine 1 receptor was significantly associated with ischemic stroke (adjusted risk ratio = 1.72, P = .037), and the sensitivity analysis based on the 7-day window of exposure validated the association (adjusted risk ratio = 1.87, P = .015). Conclusions: Use of second-generation antipsychotic drugs appeared to be associated with an increased risk of ischemic stroke in the patients studied, possibly mediated by high affinity for histamine-1 receptor blockade. Further research regarding the underlying biological mechanism and drug safety is suggested. © 2017 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 關聯 PLoS ONE, 12(6), e0179424 資料類型 article DOI http://dx.doi.org/10.1371/journal.pone.0179424 dc.contributor 心理系 - dc.creator (作者) Chen, Wen-Yin en-US dc.creator (作者) Chen, Lian-Yu en_US dc.creator (作者) Liu, Hsing-Cheng en_US dc.creator (作者) Wu, Chi-Shin en_US dc.creator (作者) Yang, Shu-Yu en_US dc.creator (作者) Pan, Chun-Hung en_US dc.creator (作者) Tsai, Shang-Ying en_US dc.creator (作者) Chen, Chiao-Chicy en_US dc.creator (作者) Kuo, Chian-Jue en_US dc.date (日期) 2017-06 - dc.date.accessioned 27-Jul-2017 12:44:06 (UTC+8) - dc.date.available 27-Jul-2017 12:44:06 (UTC+8) - dc.date.issued (上傳時間) 27-Jul-2017 12:44:06 (UTC+8) - dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/111415 - dc.description.abstract (摘要) Background: The association between antipsychotic use and the risk of stroke in schizophrenic patients is controversial. We sought to study the association in a nationwide cohort with schizophrenia. Methods: Using a retrospective cohort of patients with schizophrenia (N = 31,976) derived from the Taiwan National Health Insurance Research Database, 802 new-onset cases of stroke were identified within 10 years of follow-up (from 2000 through 2010). We designed a casecrossover study using 14-day windows to explore the risk factors of stroke and the association between antipsychotic drugs and the risk of stroke. We analyzed the risks of individual antipsychotics on various subgroups of stroke including ischemic, hemorrhagic, and other strokes, and the risks based on the antipsychotic receptor-binding profile of each drug. Results: Use of any second-generation antipsychotic was associated with an increased risk of stroke (adjusted risk ratio = 1.45, P = .009) within 14 days while the use of any first-generation antipsychotic was not. Intriguingly, the use of any second-generation antipsychotic was associated with ischemic stroke but not hemorrhagic stroke. The antipsychotic receptor-binding profile analysis showed that the antihistamine 1 receptor was significantly associated with ischemic stroke (adjusted risk ratio = 1.72, P = .037), and the sensitivity analysis based on the 7-day window of exposure validated the association (adjusted risk ratio = 1.87, P = .015). Conclusions: Use of second-generation antipsychotic drugs appeared to be associated with an increased risk of ischemic stroke in the patients studied, possibly mediated by high affinity for histamine-1 receptor blockade. Further research regarding the underlying biological mechanism and drug safety is suggested. © 2017 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. - dc.format.extent 1352689 bytes - dc.format.mimetype application/pdf - dc.relation (關聯) PLoS ONE, 12(6), e0179424 - dc.title (題名) Antipsychotic medications and stroke in schizophrenia: A case-crossover study en-US dc.type (資料類型) article - dc.identifier.doi (DOI) 10.1371/journal.pone.0179424 - dc.doi.uri (DOI) http://dx.doi.org/10.1371/journal.pone.0179424 -
