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Antipsychotic use is a risk factor for hyponatremia in patients with schizophrenia: a 15-year follow-up study

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Abstract

Rationale

Hyponatremia affects 10% of patients with chronic schizophrenia and can lead to severe consequences. However, the role of antipsychotics and other risk factors in hyponatremia occurrence has remained inconsistent.

Objective

This study examined the association between antipsychotic use and hyponatremia occurrence in patients with schizophrenia.

Methods

We utilized the National Health Insurance Research Database to follow 2051 patients with schizophrenia from 1998 to 2013. Among them, 137 (6.7%) developed hyponatremia. Sociodemographic characteristics, physical comorbidities, and psychiatric treatment experiences were compared between those who had hyponatremia and those who did not. A Cox proportional hazards model was used to examine the hazard ratios (HRs) of these characteristics.

Results

In patients with hyponatremia, the mean age at first hyponatremia occurrence was 54.7 ± 13.9 years, an average of 9.5 ± 4.0 years after schizophrenia diagnosis, and 32.9% of them were off antipsychotics before hyponatremia occurrences. Age at schizophrenia diagnosis (HR = 1.1), low-income household (HR = 2.4), comorbidities (HR = 1.2), and psychiatric admissions (HR = 1.04) were associated with the risks of hyponatremia. Compared with no antipsychotic use, atypical (HR = 2.1) and typical antipsychotics (HR = 3.1) were associated with an elevated risk of hyponatremia, after adjustment for age, sex, and physical comorbidities. Carbamazepine use (HR = 2.9) was also a significant risk factor for hyponatremia (p < 0.05).

Conclusions

Antipsychotic use in patients with schizophrenia with polypharmacy should be monitored for hyponatremia occurrences. Clinicians should pay attention to the impact of poor living conditions on hyponatremia occurrence.

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Acknowledgements

This study is based on data from the National Health Insurance Research Database provided by the National Health Insurance Administration, Ministry of Health and Welfare and managed by National Health Research Institutes (Registered number NHIRD-104-027). The interpretation and conclusions contained herein do not represent those of National Health Insurance Administration, Ministry of Health and Welfare or National Health Research Institutes.

This study was financially supported by China Medical University Hospital (DMR-104-075). The supporters had no role in the design, analysis, interpretation, or publication of this study.

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Authors and Affiliations

  1. Department of Emergency Medicine, Jen-Ai Hospital, 483 Dong Rong Road, Taichung, 41265, Taiwan

    Hang-Ju Yang

  2. Department of Psychiatry, China Medical University Hospital, 2 Yude Road, Taichung, 40447, Taiwan

    Wan-Ju Cheng

  3. Department of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan

    Wan-Ju Cheng

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  1. Hang-Ju Yang
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  2. Wan-Ju Cheng
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Correspondence to Wan-Ju Cheng.

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This study was approved by the Institutional Review Board of China Medical University Hospital (CMUH103-REC2-154).

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The authors declare that they have no conflict of interest.

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Yang, HJ., Cheng, WJ. Antipsychotic use is a risk factor for hyponatremia in patients with schizophrenia: a 15-year follow-up study. Psychopharmacology 234, 869–876 (2017). https://doi.org/10.1007/s00213-017-4525-9

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  • DOI: https://doi.org/10.1007/s00213-017-4525-9

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