Dopamine D2 receptor antagonism of antipsychotics and the risk of death due to choking

Jurjen J. Luykx; Antti Tanskanen; Markku Lähteenvuo; Peter Manu; Christoph U. Correll; Alkomiet Hasan; Johannes Lieslehto; Heidi Taipale; Jari Tiihonen

doi:10.1016/j.psychres.2024.116012

Dopamine D2 receptor antagonism of antipsychotics and the risk of death due to choking

Jurjen J. Luykx^*, Antti Tanskanen, Markku Lähteenvuo, Peter Manu, Christoph U. Correll, Alkomiet Hasan, Johannes Lieslehto, Heidi Taipale, Jari Tiihonen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

The risk of fatal choking for people with schizophrenia and associations with antipsychotic medication are largely unknown. Therefore, we calculated the choking-related standardized mortality ratio for schizophrenia relative to the general population (SMR_choking). We also computed adjusted hazard ratios (aHR) of choking-related mortality for antipsychotics in a nationwide cohort of patients with schizophrenia (N = 59,916). SMR_choking was 20.5 (95 % confidence interval (CI)=17.1–23.9). The aHR was 1.74 (95 %CI=1.19–2.55) for strong dopamine 2-antagonists. For other antipsychotics, CIs included 1. Importantly, aHRs were particularly high for high dose categories of strong dopamine D2 receptor (D2R) antagonists. In conclusion, a schizophrenia diagnosis is associated with a 20-fold risk of death due to choking. This risk is elevated during use of strong D2R antagonist antipsychotics, particularly when prescribed in high dosages.

Original language	English
Article number	116012
Journal	Psychiatry Research
Volume	339
DOIs	https://doi.org/10.1016/j.psychres.2024.116012
Publication status	Published - Sept 2024
Externally published	Yes

Keywords

Antipsychotic
Choking
Clozapine
Olanzapine
Pneumonia
Quetiapine
Schizophrenia

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10.1016/j.psychres.2024.116012Licence: CC BY

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title = "Dopamine D2 receptor antagonism of antipsychotics and the risk of death due to choking",

abstract = "The risk of fatal choking for people with schizophrenia and associations with antipsychotic medication are largely unknown. Therefore, we calculated the choking-related standardized mortality ratio for schizophrenia relative to the general population (SMRchoking). We also computed adjusted hazard ratios (aHR) of choking-related mortality for antipsychotics in a nationwide cohort of patients with schizophrenia (N = 59,916). SMRchoking was 20.5 (95 % confidence interval (CI)=17.1–23.9). The aHR was 1.74 (95 %CI=1.19–2.55) for strong dopamine 2-antagonists. For other antipsychotics, CIs included 1. Importantly, aHRs were particularly high for high dose categories of strong dopamine D2 receptor (D2R) antagonists. In conclusion, a schizophrenia diagnosis is associated with a 20-fold risk of death due to choking. This risk is elevated during use of strong D2R antagonist antipsychotics, particularly when prescribed in high dosages.",

keywords = "Antipsychotic, Choking, Clozapine, Olanzapine, Pneumonia, Quetiapine, Schizophrenia",

author = "Luykx, {Jurjen J.} and Antti Tanskanen and Markku L{\"a}hteenvuo and Peter Manu and Correll, {Christoph U.} and Alkomiet Hasan and Johannes Lieslehto and Heidi Taipale and Jari Tiihonen",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = sep,

doi = "10.1016/j.psychres.2024.116012",

language = "English",

volume = "339",

journal = "Psychiatry Research",

issn = "0165-1781",

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T1 - Dopamine D2 receptor antagonism of antipsychotics and the risk of death due to choking

AU - Luykx, Jurjen J.

AU - Tanskanen, Antti

AU - Lähteenvuo, Markku

AU - Manu, Peter

AU - Correll, Christoph U.

AU - Hasan, Alkomiet

AU - Lieslehto, Johannes

AU - Taipale, Heidi

AU - Tiihonen, Jari

PY - 2024/9

Y1 - 2024/9

N2 - The risk of fatal choking for people with schizophrenia and associations with antipsychotic medication are largely unknown. Therefore, we calculated the choking-related standardized mortality ratio for schizophrenia relative to the general population (SMRchoking). We also computed adjusted hazard ratios (aHR) of choking-related mortality for antipsychotics in a nationwide cohort of patients with schizophrenia (N = 59,916). SMRchoking was 20.5 (95 % confidence interval (CI)=17.1–23.9). The aHR was 1.74 (95 %CI=1.19–2.55) for strong dopamine 2-antagonists. For other antipsychotics, CIs included 1. Importantly, aHRs were particularly high for high dose categories of strong dopamine D2 receptor (D2R) antagonists. In conclusion, a schizophrenia diagnosis is associated with a 20-fold risk of death due to choking. This risk is elevated during use of strong D2R antagonist antipsychotics, particularly when prescribed in high dosages.

AB - The risk of fatal choking for people with schizophrenia and associations with antipsychotic medication are largely unknown. Therefore, we calculated the choking-related standardized mortality ratio for schizophrenia relative to the general population (SMRchoking). We also computed adjusted hazard ratios (aHR) of choking-related mortality for antipsychotics in a nationwide cohort of patients with schizophrenia (N = 59,916). SMRchoking was 20.5 (95 % confidence interval (CI)=17.1–23.9). The aHR was 1.74 (95 %CI=1.19–2.55) for strong dopamine 2-antagonists. For other antipsychotics, CIs included 1. Importantly, aHRs were particularly high for high dose categories of strong dopamine D2 receptor (D2R) antagonists. In conclusion, a schizophrenia diagnosis is associated with a 20-fold risk of death due to choking. This risk is elevated during use of strong D2R antagonist antipsychotics, particularly when prescribed in high dosages.

KW - Antipsychotic

KW - Choking

KW - Clozapine

KW - Olanzapine

KW - Pneumonia

KW - Quetiapine

KW - Schizophrenia

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U2 - 10.1016/j.psychres.2024.116012

DO - 10.1016/j.psychres.2024.116012

M3 - Article

AN - SCOPUS:85196294749

SN - 0165-1781

VL - 339

JO - Psychiatry Research

JF - Psychiatry Research

M1 - 116012

ER -

Dopamine D2 receptor antagonism of antipsychotics and the risk of death due to choking

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Keywords

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