Arriba, M, Solmi, M, Thompson, Trevor ORCID: 0000-0001-9880-782X , Oliver, D and Fusar-Poli, P (2022) Timing of antipsychotics and benzodiazepine initiation during a first episode of psychosis impacts clinical outcomes: electronic health record cohort study. Frontiers in Psychiatry, 13:976035. ISSN 1664-0640 (Online) (doi:https://doi.org/10.3389/fpsyt.2022.976035)

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Abstract

The impact of timing of antipsychotics and benzodiazepine treatment during a first episode of psychosis on clinical outcomes is unknown. We present a RECORD-compliant electronic health record cohort study including patients (n = 4,483, aged 14–35) with a primary diagnosis of any non-organic ICD-10 first episode of psychosis at SLAM-NHS between 2007 and 2017. The impact of antipsychotic timing (prescription > 1 week after a first episode of psychosis) was assessed on the primary outcome (risk of any psychiatric inpatient admission over 6 years), and secondary outcomes (cumulative duration of anympsychiatric/ medical/ accident/ emergency [A&E] admission over 6 years). The impact of prescribing benzodiazepine before antipsychotic at any point and of treatment patterns (antipsychotic alone, benzodiazepine alone, combination of antipsychotic with benzodiazepine) within the first week after a first episode of psychosis were also assessed. Survival analyses and zero-inflated negative binomial regressions, adjusted for core covariates, and complementary analyses were employed. Antipsychotic prescribed >1 week after a first episode of psychosis did not affect the risk of any psychiatric admission (HR = 1.04, 95% CI = 0.92–1.17, p = 0.557), but increased the duration of any psychiatric (22–28%), medical (78–35%) and A&E (30–34%) admission (months 12–72). Prescribing benzodiazepine before antipsychotic at any point did not affect the risk of any psychiatric admission (HR = 1.03, 95% CI = 0.94–1.13, p = 0.535), but reduced the duration of any psychiatric admission (17–24%, months 12–72), and increased the duration of medical (71–45%, months 12–72) and A&E (26–18%, months 12–36) admission. Prescribing antipsychotic combined with benzodiazepine within the first week after a first episode of psychosis showed better overall clinical outcomes than antipsychotic or benzodiazepine alone. Overall, delaying antipsychotic 1 week after a first episode of psychosis may worsen some clinical outcomes. Early benzodiazepine treatment can be considered with concomitant antipsychotic but not as standalone intervention.

Item Type:	Article
Uncontrolled Keywords:	antipyschotics; benzodiazepines (BDZ); first-episode; psychosis; treatment; electronic-health record (HER); first episode psychoses; cohort study
Subjects:	R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry R Medicine > RM Therapeutics. Pharmacology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	26 Sep 2022 09:44
URI:	http://gala.gre.ac.uk/id/eprint/37538

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