Antipsychotics and Their Association With Long‐Term Outcomes in Young Ischemic Stroke Patients

BACKGROUND: Psychotic disorders and use of antipsychotics prior to or after ischemic stroke (IS) may be associated with poor outcomes. However, data on antipsychotic use in young IS patients are limited. We aimed to characterize young patients purchasing antipsychotics prior to IS or de novo post-stroke, and to examine their association with long-term outcomes. METHODS: We analyzed data from the Helsinki Young Stroke Registry, including 1008 consecutive patients aged 15-49 with first-ever IS 1994-2007. We considered patients without antipsychotic purchases as non-users, those with at least one purchase any time before IS as prior users, and those who had purchases at any time after IS (but not before) as de novo users. Cox regression models assessed the association of antipsychotic purchases with any recurrent vascular event or all-cause mortality. RESULTS: Of 966 included IS survivors (62.6% male, median age 44), 55 (5.7%) purchased antipsychotics before and 67 (6.9%) after index IS. Compared with de novo or non-users, prior users more often had other/unknown socioeconomic status, a history of psychiatric hospitalization, drug abuse, smoking, heavy drinking, more severe stroke symptoms on admission, and limb paresis at discharge. Antipsychotics purchased before IS were associated with a heightened hazard of endpoint events when adjusted for sociodemographics and cardiovascular comorbidities. The association was not found for de novo users. CONCLUSIONS: Around 6% of young IS patients had a history of antipsychotic use, while a similar proportion initiated antipsychotics post-stroke. Pre-stroke antipsychotic use was associated with recurrent vascular events and mortality.