ArticleSchizophrenia bulletin2021
Risk Factors, Incidence, and Outcomes of Neuroleptic Malignant Syndrome on Long-Acting Injectable vs Oral Antipsychotics in a Nationwide Schizophrenia Cohort.
Article in Schizophrenia bulletin, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Clozapine Optimization: A Delphi Consensus Guideline From the Treatment Response and Resistance in Psychosis Working Group.Schizophrenia bulletin · 2023Guideline
- Long-Acting Injectable Antipsychotic Treatment in Schizophrenia and Co-occurring Substance Use Disorders: A Systematic Review.Frontiers in psychiatry · 2021Pooled it
- Translating Pharmacokinetics and Pharmacodynamics into Clinical Decision-Making: A Practical Guide to the Use of Risperidone ISMJournal of clinical medicine · 2026Review
- Early Recognition of Neuroleptic Malignant Syndrome Without Hyperthermia: A Narrative Review.Cureus · 2026Review
- Perception and willingness toward second-generation long-acting antipsychotics among patients with schizophrenia: a cross-sectional survey in Fujian, China.Frontiers in psychiatry · 2026Article
- Clinical Outcomes and Factors Associated with Neuroleptic Malignant Syndrome in Older Patients: A Case Control Study.Journal of clinical medicine · 2025Article
- Long-acting injectable antipsychotics for patients with first-episode and early-phase schizophrenia: still not considered often enough.CNS spectrums · 2025Review
- Associations between clozapine availability, the diagnosis of treatment-resistant schizophrenia subgroups, antipsychotic monotherapy, and concomitant psychotropics among patients with schizophrenia: a real-world nationwide study.The international journal of neuropsychopharmacology · 2025Article
- Incidence of Neuroleptic Malignant Syndrome During Antipsychotic Treatment in Children and Youth: A National Cohort Study.Journal of child and adolescent psychopharmacology · 2024Article
- Neurofeedback technique for treating male schizophrenia patients with impulsive behavior: a randomized controlled study.Frontiers in psychiatry · 2024Article
- Catatonia-related adverse outcomes after long-acting injectable antipsychotics: Case series.SAGE open medical case reports · 2024Article
- Atypical Neuroleptic Malignant Syndrome With Type 2 Respiratory Failure Treated With Non-invasive Ventilation.Cureus · 2024Article
- Serious adverse drug events associated with psychotropic treatment of bipolar or schizoaffective disorder: a 17-year follow-up on the LiSIE retrospective cohort study.Frontiers in psychiatry · 2024Article
- Symptomatic, functional and quality of life measures of remission in 194 outpatients with schizophrenia followed naturalistically in a 6-month, non-interventional study of aripiprazole once-monthly.Schizophrenia (Heidelberg, Germany) · 2023Article
- Review
- Candidate biomarkers in psychiatric disorders: state of the field.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2023Article
- Article
- Tolerability profile of paliperidone palmitate formulations: A pharmacovigilance analysis of the EUDRAVigilance database.Frontiers in psychiatry · 2023Article
- The place of long-acting injectable antipsychotics in the treatment of schizophrenia.Therapeutic advances in psychopharmacology · 2023Article
- Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study.The international journal of neuropsychopharmacology · 2022Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionLong-acting injectable antipsychotics (LAIs) are associated with multiple positive outcomes in psychosis, but it is unclear whether LAIs are associated with worse outcomes if neuroleptic malignant syndrome (NMS), a potentially lethal adverse effect, occurs.
methodsWe used nationwide and nationally representative databases of healthcare encounters in Finland to study the incidence and outcome predictors of NMS in patients diagnosed with schizophrenia/schizoaffective disorder between January 01, 1972 and December 31, 2017. Using a nested case-control design, we also explored differences by antipsychotic formulation (LAI vs oral antipsychotic [OAP]) and class (first-generation antipsychotic [FGA] vs second-generation antipsychotic [SGA]).
resultsOne hundred seventy-two NMS cases and 1441 sex-, age-, and diagnosis-matched controls were included (age = 58.8 ± 13.1 years, males = 59.9%). Incidence of NMS was 1.99 (1.98-2.00) per 10 000 person-years. The likelihood of developing NMS did not differ by antipsychotic formulation (adjusted odds ratio [aOR]: 0.89, 95% confidence intervals [95% CI]: 0.59-1.33, for LAIs vs OAPs) or class (FGA-OAP vs SGA-OAP [aOR: 1.08, 95% CI: 0.66-1.76], FGA-LAI [aOR: 0.89, 95% CI: 0.52-1.53], SGA-LAI [aOR: 1.35, 95% CI: 0.58-3.12]). NMS risk factors included antipsychotic treatment change: increased number (odds ratios [OR]: 5.00, 95% CI: 2.56-9.73); decreased number/switch (OR: 2.43, 95% CI: 1.19-4.96); higher antipsychotic dose (>2DDDs-OR: 3.15, 95% CI: 1.61-6.18); co-treatment with anticholinergics (OR: 2.26, 95% CI: 1.57-3.24), lithium (OR: 2.16, 95% CI: 1.30-3.58), benzodiazepines (OR: 2.02, 95% CI: 1.44-3.58); and comorbid cardiovascular disease (OR: 1.73, 95% CI: 1.22-2.45). Within 30 days, 4.7% of cases with NMS died (15.1% within 1 year) without differences by antipsychotic formulation. NMS reoccurred in 5 of 119 subjects (4.2%), after a median = 795 (range = 77-839) days after rechallenge with antipsychotics.
conclusionNMS remains a potentially life-threatening risk, yet these results should further contribute to mitigate concerns about LAI safety regarding NMS onset or outcomes, including mortality.
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