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Children and youth 5-24 yo on Medicaid
New users of second generation antipsychotic medications (low-dose vs. high dose) for conditions other than psychotic disorders vs. controls using either ADHD meds, antidepressants, or non-antipsychotic mood stabilizers
58,497 new users of antipsychotic medications
28,377 low-dose (66% Risperdal)
30,120 high-dose (34.3% Seroquel, 23.4% Abilify, 6.6% Zyprexa)
189,361 new users of control meds
42.9% ADHD meds (most frequently stimulants)
49.6% antidepressants (most frequently SSRIs)
7.5% mood stabilizers (most frequently anticonvulsants)
Person-years of follow-up
123,005 in control group
16,159 in low-dose antipsychotic group
27,354 in high-dose antipsychotic group
Unexpected deaths
67 (54.5 per 100,000 person-years) in the control group
67.2% from injuries and deaths from suicides
8 (49.5 per 100,000 person-years) in the low-dose antipsychotic group
40 (146.2 per 100,000 person-years) in the high-dose antipsychotic group
Risk after adjustment for covariates
Risk of death in the high-dose antipsychotic group 80% greater than in the control group
The adjusted hazard ratio for unexpected deaths was 3.51, with 45 excess deaths per 100,000 person-years
Cardiovascular and metabolic risk the greatest
Risk of death from injury or suicide was not increased (hazard ratio of 1.03)
No increased risk of total mortality in low-dose antipsychotic group