Format

Send to

Choose Destination
Schizophr Res. 2016 Jul;174(1-3):150-155. doi: 10.1016/j.schres.2016.03.021. Epub 2016 Apr 8.

Inverse association between urbanicity and treatment resistance in schizophrenia.

Author information

1
National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Denmark. Electronic address: tw@econ.au.dk.
2
National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark.
3
Department of Psychosis Studies, The Institute of Psychiatry Psychology and Neuroscience, King's College London, United Kingdom.
4
Department of Public Health, Biostatistics, Aarhus University, Denmark.
5
National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Denmark.
6
Research unit , Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Denmark.

Abstract

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: 7years, inter-quartile range: 3-12years). 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.

KEYWORDS:

Antipsychotics; Clozapine; Schizophrenia; Treatment resistance; Urbanicity

PMID:
27066856
DOI:
10.1016/j.schres.2016.03.021
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center