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Antipsychotics Linked with Unexpected Child Deaths

JAMA Psychiatry; ePub 2018 Dec 12; Ray, Stein, et al

Recent findings suggest that antipsychotic use is associated with increased risk of unexpected death in children and youths and appear to reinforce recommendations for careful prescribing and monitoring of antipsychotic treatment. Researchers conducted a retrospective cohort study from 1999 through 2014 and included Medicaid enrollees aged 5 to 24 years who had no diagnosis of severe somatic illness, schizophrenia or related psychoses, or Tourette syndrome or chronic tic disorder. Included were 189,361 children and youths in the control group (mean [SD] age, 12.0 [5.1] years; 43.4% female), 28,377 in the lower-dose group (mean [SD] age, 11.7 [4.4] years; 32.3% female), and 30,120 in the higher-dose group (mean [SD] age, 14.5 [4.8] years; 39.2% female). They found:

  • The unadjusted incidence of death in the higher-dose group was 146.2 per 100,000 person-years (40 deaths per 27,354 person-years), which was significantly greater than that in the control group (54.5 per 100,000 population; 67 deaths per 123,005 person-years).
  • The difference was primarily attributable to the increased incidence of unexpected deaths in the higher-dose group (21 deaths; 76.8 per 100,000 population) compared with the control group (22 deaths; 17.9 per 100,000 population).

Ray WA, Stein M, Murray KT, et al. Association of antipsychotic treatment with risk of unexpected death among children and youths. [Published online ahead of print December 12, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.3421.