Inverse association between urbanicity and treatment resistance in schizophrenia

SCHIZOPHRENIA RESEARCH

卷:174

Article

Wimberley, Theresa¹  Pedersen, Carsten B.^1,2,3  MacCabe, James H.⁴  Stovring, Henrik⁵  Astrup, Aske¹  Sorensen, Holger J.⁶  Horsdal, Henriette T.¹  Mortensen, Preben B.^1,2,3  Gasse, Christiane¹ 

[1] Aarhus Univ, Sch Business & Social Sci, Natl Ctr Register Based Res, Fuglesangs Alle 4, DK-8210 Aarhus, Denmark

[2] Aarhus Univ, CIRRAU, Ctr Integrated Register Based Res, DK-8210 Aarhus, Denmark

[3] iPSYCH, Lundbeck Fdn Initiat Integrat Psychiat Res, Aarhus, Denmark

[4] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychosis Studies, London WC2R 2LS, England

[5] Aarhus Univ, Biostat, Dept Publ Hlth, DK-8210 Aarhus, Denmark

[6] Univ Copenhagen, Fac Hlth Sci, Mental Hlth Ctr Copenhagen, Res Unit, DK-1168 Copenhagen, Denmark

关键词: Schizophrenia;    Treatment resistance;    Urbanicity;    Antipsychotics;    Clozapine;   

DOI  :  10.1016/j.schres.2016.03.021

来源: Elsevier

【 摘 要 】

Background: Living in a larger city is associated with increased risk of schizophrenia; and world-wide, consistent evidence shows that the higher the degree of urbanicity the higher the risk of schizophrenia. However, the association between urbanicity and treatment-resistant schizophrenia (TRS) as a more severe form of schizophrenia or separate entity of schizophrenia has not been fully explored yet. We aimed to investigate the association between urbanicity and incidence of TRS. Methods: A large Danish population-based cohort of all individuals with a first schizophrenia diagnosis after 1996 was followed until 2013 applying survival analysis techniques. TRS was assessed using a treatment-based proxy, defined as the earliest observed instance of either clozapine initiation or hospital admission due to schizophrenia after having received two prior antipsychotic monotherapy trials of adequate duration. Results: Among the 13,349 schizophrenia patients, 17.3% experienced TRS during follow-up (median follow-up: 7 years, inter-quartile range: 3-12 years). The 5-year risk of TRS ranged from 10.5% in the capital area to 17.6% in the rural areas. Compared with individuals with schizophrenia residing in the capital area, hazard ratios were 1.44 (1.31-1.59) for provincial areas and 1.60 (1.43-1.79) for rural areas. Conclusion: Higher rates of TRS were found in less urbanized areas. The different direction of urban-rural differences regarding TRS and schizophrenia risk may indicate urban-rural systematic differences in treatment practices, or different urban-rural aetiologic types of schizophrenia. (C) 2016 Elsevier B.V. All rights reserved.

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