The predictive role of family history of antipsychotic drug use in poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH).

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) primarily impacts the working-age population. We have shown that 12-month survivors of aSAH from a defined population have increased use of antipsychotic drugs (APD) after aSAH. Research question: Does familial psychiatric burden associate with the risk of APD use or having a poor outcome (mRS 3-5) after aSAH? Material and methods: In our retrospective case-control study, we included consecutive 12-month survivors of aSAH admitted to Kuopio University Hospital with a first aSAH from 1995 to 2018 from its defined catchment population. From national health registries, data were retrieved and linked to aSAH patients, relatives, and matched population controls. Results: Of 1347 aSAH patients (median age 54; 53 % females, median follow-up 11 years), a total of 187 (14 %) had started APD use only after the aSAH. Among 10 820 relatives, 1070 (10 %) with APD use were identified. In overall, 79 aSAH survivors with a family history of APD use or psychiatric diagnoses were not at increased risk of initiating APD use after aSAH (OR 0.79, 95 % CI 0.58-1.09). 84 (51 %) of 166 aSAH survivors with a 12-month poor outcome had a positive family history. Positive family history was an independent risk for poor outcome (OR 1.87, 95 % CI 1.28-2.73). Discussion and conclusion: The family history of APD use or psychiatric diagnoses was not a risk factor for APD use but was an independent risk factor for poor outcome at 12 months after aSAH. This should be considered in the rehabilitation and follow-up programs.