Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study

Br J Psychiatry. 1998 Oct;173:325-9. doi: 10.1192/bjp.173.4.325.


Background: Although increased mortality is one of the most consistent and accepted epidemiological findings in schizophrenia, a high rate of suicide appears unable to account fully for this burden which remains poorly understood.

Method: A cohort of 88 in-patients was followed prospectively over a 10-year period and predictors of survival sought among demographic, clinical and treatment variables.

Results: Over the decade, 39 of the 88 patients (44%) died, with no instances of suicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre-terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival: maximum number of antipsychotics given concurrently (relative risk 2.46, 95% CI 1.10-5.47; P = 0.03) and absence of co-treatment with an anticholinergic (relative risk 3.33, 95% CI 0.99-11.11; P = 0.05).

Conclusions: Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use of antipsychotic polypharmacy. Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / therapeutic use
  • Cholinergic Antagonists / therapeutic use
  • Cohort Studies
  • Female
  • Humans
  • Ireland / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies
  • Schizophrenia / drug therapy
  • Schizophrenia / mortality*
  • Sex Factors
  • Survival Analysis


  • Antipsychotic Agents
  • Cholinergic Antagonists