Antipsychotic drug use after aSAH signals more severe brain injury
Use of antipsychotic drugs (APDs) in survivors of aneurysmal subarachnoid haemorrhage (aSAH) correlates with the extent of brain injury from aSAH, such that APD exposure is minimal in the absence of significant brain injury, a study has found.
Researchers looked at patterns of APD use in 1,144 consecutive aSAH patients alive at 12 months of index event and in 3,432 matched controls over a median follow-up of 9 years. Drug purchase and hospital discharge data were obtained using the Finish nationwide health registries.
First-time APD use was recorded in 140 patients (12 percent) after the index aSAH event and in 145 controls (4 percent). The cumulative rate of initiating APD was 6 percent at 1 year and 9 percent at 5 years in the aSAH group and 1 percent and 2 percent, respectively, in the control group.
In the subgroup of 489 patients with a good condition (modified Rankin Scale score of 0 or 1 at 12 months; no shunt, intracerebral haemorrhage or intraventricular haemorrhage) both at admission and at 12 months after aSAH, the cumulative rates of APD use at 1 and 5 years were only 1 percent and 2 percent.
The highest cumulative rate of APD use was 23 percent at 5 years, which was recorded among the 192 patients shunted for hydrocephalus after aSAH.
Of the aSAH patients with APD exposure, 88 (63 percent) also used antidepressant or antiepileptic drug concomitantly.
The present data suggest that APD use after aSAH may be used as a marker of more severe brain injury and forecast a worse long-term overall outcome, the researchers said. Furthermore, the possibility of psychotic disorders should be considered in outpatient clinics treating aSAH survivors.