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LB-102

Schizophrenia

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345 sources

Product information and disease descriptionPlace of product in therapyDisease description

Natural history, survival, and mortality

11 evidence topics · 21 sources

Prodrome: duration and transition to psychosis from the clinical high-risk state

“Of the 764 participants identified as being at CHR-P, 94 converted to psychosis and 92 of these had recorded estimates of prodrome onset.” (opens the source at this quote in a new tab)

“Results identified a mean prodrome duration of 21.6 months.” (opens the source at this quote in a new tab)

“one third of CHR-P patients who convert will do so by 1 year after CHR-P syndrome onset, another third 1–2 years after onset, and the final third more than 2 years after onset.” (opens the source at this quote in a new tab)

“In this meta-analysis of 130 longitudinal studies, including 9222 individuals at clinical high risk for psychosis from 74 cohorts, the risk of developing psychosis continued increasing after 2 years, cumulating to 25% at 3 years and reaching 35% at 10 years.” (opens the source at this quote in a new tab)

“There was a consistent transition risk, independent of the psychometric instruments used, of 18% after 6 months of follow-up, 22% after 1 year, 29% after 2 years, and 36% after 3 years.” (opens the source at this quote in a new tab)

Course: episodic or progressive pattern after onset

“At least one third of people with schizophrenia achieve complete remission of symptoms” (opens the source at this quote in a new tab)

“Some people with schizophrenia experience worsening and remission of symptoms periodically throughout their lives, others a gradual worsening of symptoms over time.” (opens the source at this quote in a new tab)

“Insidious onset, childhood or adolescent onset, poor premorbid adjustment, substance use, and cognitive impairment are indicative of a poor prognostic outcome in schizophrenia. Acute onset and living in a developed country signal comparatively better prognostic factors.” (opens the source at this quote in a new tab)

Relapse after response to treatment of a first episode

“The sample for the relapse analyses consisted of 104 patients who responded to treatment of their index episode and were at risk for relapse.” (opens the source at this quote in a new tab)

“Five years after initial recovery, the cumulative first relapse rate was 81.9% (95% confidence interval [CI], 70.6%-93.2%); the second relapse rate was 78.0% (95% CI, 46.5%-100.0%). By 4 years after recovery from a second relapse, the cumulative third relapse rate was 86.2% (95% CI, 61.5%-100.0%). Discontinuing antipsychotic drug therapy increased the risk of relapse by almost 5 times (hazard ratio for an initial relapse, 4.89 [99% CI, 2.49-9.60]; hazard ratio for a second relapse, 4.57 [99% CI, 1.49-14.02]).” (opens the source at this quote in a new tab)

Relapse after antipsychotic discontinuation

“Six studies were identified that met our criteria and these reported a weighted mean one-year recurrence rate of 77% following discontinuation of antipsychotic medication. By two years, the risk of recurrence had increased to over 90%. By comparison, we estimated the one-year recurrence rate for patients who continued antipsychotic medication to be 3%.” (opens the source at this quote in a new tab)

“We identified 116 suitable reports from 65 trials, with data for 6493 patients. Antipsychotic drugs significantly reduced relapse rates at 1 year (drugs 27% vs placebo 64%; risk ratio [RR] 0·40, 95% CI 0·33-0·49; number needed to treat to benefit [NNTB] 3, 95% CI 2-3). Fewer patients given antipsychotic drugs than placebo were readmitted (10% vs 26%; RR 0·38, 95% CI 0·27-0·55; NNTB 5, 4-9), but less than a third of relapsed patients had to be admitted.” (opens the source at this quote in a new tab)

“Relapse rates are very high when treatment is discontinued, even after a single psychotic episode; a longer treatment period prior to discontinuation does not reduce the risk of relapse; many patients relapse soon after treatment reduction and discontinuation; transition from remission to relapse may be abrupt and with few or no early warning signs; once illness recurrence occurs symptoms rapidly return to levels similar to the initial psychotic episode; while most patients respond promptly to re-introduction of antipsychotic treatment after relapse, the response time is variable and notably, treatment failure appears to emerge in about 1 in 6 patients.” (opens the source at this quote in a new tab)

Remission and recovery rates

“We identified 50 studies with data suitable for inclusion. The median proportion (25%–75% quantiles) who met our recovery criteria was 13.5% (8.1%–20.0%).” (opens the source at this quote in a new tab)

“The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years).” (opens the source at this quote in a new tab)

“The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years).” (opens the source at this quote in a new tab)

All-cause mortality relative to the general population

“Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all‐cause mortality was increased in people with schizophrenia versus any non‐schizophrenia control group (RR=2.52, 95% CI: 2.38‐2.68, n=79), with the largest risk in first‐episode (RR=7.43, 95% CI: 4.02‐13.75, n=2) and incident (i.e., earlier‐phase) schizophrenia (RR=3.52, 95% CI: 3.09‐4.00, n=7) versus the general population.” (opens the source at this quote in a new tab)

“On the basis of the standardized mortality ratio, people with schizophrenia have a two- to threefold increased risk of dying (median standardized mortality ratio = 2.6 for all-cause mortality), and this differential gap in mortality has increased over recent decades.” (opens the source at this quote in a new tab)

Mortality in United States Medicaid beneficiaries with schizophrenia

“The cohort included 1,138,853 individuals, 4,807,121 years of follow-up, and 74,003 deaths, of which 65,553 had a known cause.” (opens the source at this quote in a new tab)

“Adults with schizophrenia were more than 3.5 times (all-cause SMR, 3.7; 95% CI, 3.7-3.7) as likely to die in the follow-up period as were adults in the general population. Cardiovascular disease had the highest mortality rate (403.2 per 100,000 person-years) and an SMR of 3.6 (95% CI, 3.5-3.6).” (opens the source at this quote in a new tab)

“Accidental deaths (119.7 per 100,000 person-years) accounted for more than twice as many deaths as suicide (52.0 per 100,000 person-years).” (opens the source at this quote in a new tab)

Life expectancy and years of potential life lost

“Schizophrenia was associated with a weighted average of 14·5 years of potential life lost (95% CI 11·2-17·8), and was higher for men than women (15·9, 13·8-18·0 vs 13·6, 11·4-15·8).” (opens the source at this quote in a new tab)

“The overall weighted average life expectancy was 64·7 years (95% CI 61·1-71·3), and was lower for men than women (59·9 years, 95% CI 55·5-64·3 vs 67·6 years, 63·1-72·1).” (opens the source at this quote in a new tab)

“The estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years.” (opens the source at this quote in a new tab)

Cause-specific mortality

“Specific‐cause mortality was highest for suicide or injury‐poisoning or undetermined non‐natural cause (RR=9.76‐8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79‐7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4)” (opens the source at this quote in a new tab)

“Particularly elevated SMRs were observed for chronic obstructive pulmonary disease (9.9; 95% CI, 9.6-10.2) and influenza and pneumonia (7.0; 95% CI, 6.7-7.4).” (opens the source at this quote in a new tab)

Suicide: lifetime risk and rates

“The estimate of lifetime suicide prevalence in those observed from first admission or illness onset was 5.6% (95% confidence interval, 3.7%-8.5%).” (opens the source at this quote in a new tab)

“This study estimates that 4.9% of schizophrenics will commit suicide during their lifetimes, usually near illness onset.” (opens the source at this quote in a new tab)

“Consensus on the lifetime risk of suicide was a rate of approximately 5%. Risk factors with a strong association with later suicide included being young, male, and with a high level of education.” (opens the source at this quote in a new tab)

“The total suicide rate per 100 000 person-years was 74.00, which is 4.5 times higher than that for the general US population (SMR, 4.54; 95% CI, 4.35-4.73) and included a rate of 88.96 for men and 56.33 for women, which are 3.4 (SMR, 3.39; 95% CI, 3.22-3.57) and 8.2 (SMR, 8.16; 95% CI, 7.60-8.75) times higher, respectively, than the rates for the general US population.” (opens the source at this quote in a new tab)

“In this cohort study of 668 836 patients with schizophrenia and Medicare coverage, the risk of suicide was higher compared with the general US population and was highest among those aged 18 to 34 years and lowest among those 65 years and older.” (opens the source at this quote in a new tab)

“About 4%−10% of persons with schizophrenia die by suicide, with rates that are highest among males in the early course of the disorder” (opens the source at this quote in a new tab)

Mortality by antipsychotic exposure: 20-year Finnish cohort

“The cumulative mortality rates during maximum follow‐up of 20 years were 46.2% for no antipsychotic use, 25.7% for any antipsychotic use, and 15.6% for clozapine use.” (opens the source at this quote in a new tab)