TY - JOUR

T1 - Psychopharmacological treatment patterns prior to a schizophrenia diagnosis

T2 - A Danish nationwide study

AU - Rohde, Christopher

AU - Højlund, Mikkel

AU - Gasse, Christiane

AU - Hauser, Alexander S.

AU - Petersen, Liselotte V.

AU - Christensen, Rune H.

AU - Benros, Michael E.

AU - Hallas, Jesper

AU - Mors, Ole

AU - Köhler-Forsberg, Ole

N1 - Funding Information: CR received the 2020 Lundbeck Foundation Talent Prize. MH reports personal honoraria from the Lundbeck Foundation and support from the Mental Health Services in the Region of Southern Denmark. OKF reports honoraria for lectures for Lundbeck Pharma A/S. All other authors report no conflicts of interest.

PY - 2022

Y1 - 2022

N2 - Background: Many patients with schizophrenia experience psychiatric symptoms long before being diagnosed. We investigated patterns of pre-diagnostic psychopharmacological treatment in individuals diagnosed with first-episode schizophrenia during the last two decades. Design: Using Danish nationwide healthcare registers, we identified all individuals aged ≥10 years registered with their first ICD-10 schizophrenia diagnosis between January 1999 and March 2019. For each calendar year from 1999 to 2019, we calculated the proportion of patients – among those having received their first schizophrenia diagnosis in the respective calendar year – who redeemed prescriptions for various psychotropics in the two years preceding the schizophrenia diagnosis. We calculated proportions of all pre-diagnostic prescriptions since 1995 for a sub-population diagnosed 2011–2019 and for an age- and sex-matched reference group without schizophrenia. Results: Among 33,361 individuals with schizophrenia (58 % males), the schizophrenia incidence rate was stable during the study period but the mean age at diagnosis decreased by >10 years. In the two pre-diagnostic years, 69 % received psychopharmacological treatment (52 % antipsychotics, 40 % antidepressants). This was stable between 1999 and 2019. Among 14,425 individuals diagnosed 2011–2019, psychotropic drug use was observed among 14–20 % between 24 and 10 years before the diagnosis, being four times higher than the reference group. Particularly antipsychotic and antidepressant drug use increased steadily during the ten pre-diagnostic years. Conclusions: Pre-diagnostic psychotropic drug use in schizophrenia was frequent but stable between 1999 and 2019 despite an earlier identification of schizophrenia patients. Our findings emphasize the continued importance of thorough diagnostic interviews, particularly among patients in need of antipsychotic treatment.

AB - Background: Many patients with schizophrenia experience psychiatric symptoms long before being diagnosed. We investigated patterns of pre-diagnostic psychopharmacological treatment in individuals diagnosed with first-episode schizophrenia during the last two decades. Design: Using Danish nationwide healthcare registers, we identified all individuals aged ≥10 years registered with their first ICD-10 schizophrenia diagnosis between January 1999 and March 2019. For each calendar year from 1999 to 2019, we calculated the proportion of patients – among those having received their first schizophrenia diagnosis in the respective calendar year – who redeemed prescriptions for various psychotropics in the two years preceding the schizophrenia diagnosis. We calculated proportions of all pre-diagnostic prescriptions since 1995 for a sub-population diagnosed 2011–2019 and for an age- and sex-matched reference group without schizophrenia. Results: Among 33,361 individuals with schizophrenia (58 % males), the schizophrenia incidence rate was stable during the study period but the mean age at diagnosis decreased by >10 years. In the two pre-diagnostic years, 69 % received psychopharmacological treatment (52 % antipsychotics, 40 % antidepressants). This was stable between 1999 and 2019. Among 14,425 individuals diagnosed 2011–2019, psychotropic drug use was observed among 14–20 % between 24 and 10 years before the diagnosis, being four times higher than the reference group. Particularly antipsychotic and antidepressant drug use increased steadily during the ten pre-diagnostic years. Conclusions: Pre-diagnostic psychotropic drug use in schizophrenia was frequent but stable between 1999 and 2019 despite an earlier identification of schizophrenia patients. Our findings emphasize the continued importance of thorough diagnostic interviews, particularly among patients in need of antipsychotic treatment.

KW - Antidepressant

KW - Antipsychotic

KW - Pre-diagnostic

KW - Prodromal

KW - Schizophrenia

U2 - 10.1016/j.schres.2022.06.034

DO - 10.1016/j.schres.2022.06.034

M3 - Journal article

C2 - 35858504

AN - SCOPUS:85134572264

VL - 246

SP - 268

EP - 276

JO - Schizophrenia Research

JF - Schizophrenia Research

SN - 0920-9964

ER -