Real-world effectiveness of pharmacological treatment

Research topics and goals

Nowadays, most treatment guidelines are largely based on randomized controlled trials (RCTs), but also observational studies can give important contribution to evidence-based medicine. The patient populations in RCTs are highly selected, and follow-up periods are short and, therefore, the generalization of RCTs to real-world settings is questionable. Also, studying infrequent phenomena, such as death and suicide, is practically impossible in RCTs. We study the real-world effectiveness of psychopharmacological treatments of psychoses and depression by using nationwide hospital discharge, prescription and mortality registers.

We have shown that in the treatment of schizophrenia, use of antipsychotic is associated with decreased mortality compared with no use of antipsychotic, and clozapine is associated with lower mortality than other antipsychotics. We have also observed that benzodiazepine use is linked with increased mortality, whereas use of an antidepressant or several concomitant antipsychotics is not. In first episode patients, use of depot antipsychotic injections leads to decreased risk of rehospitalization.

Now we are studying the effectiveness of antipsychotics, mood stabilizers, and antidepressants in the relapse and suicide prevention in dipolar disorders.

Latest achievements

  • Welfare and health: The publications concerning pharmacoepidemiology have already had international influence to treatment guidelines concerning schizophrenia (Kunskapcentrum för hälso- och sjukvården, SBU, Sweden; Skitsofrenian Käypä hoito-suositus, Finland).

Research methods

  • Real-world effectiveness of treatments by using nationwide hospital discharge, prescription and mortality registers.

Group leader

Professor Jari Tiihonen
Karolinska Institutet
Department of Clinical Neuroscience
K8, CPF, Byggnad R5:00
S-171 76 Stockholm
Sweden
Tel. +358 50 341 8363
e-mail: jari.tiihonen(at)ki.se

Present positions

  • Professor, Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
  • Professor, University of Eastern Finland, Department of Forensic Psychiatry, Kuopio, Finland

Major research interests

  • Psychiatry, psychopharmacology, functional brain imaging, autoradiography studies on dopamine and serotonin receptors and transporters in the human brain; epidemiology, genetics and neurobiology of substance dependence; violent and suicidal behavior

Previous major positions and appointments

  • Professor, University of Eastern Finland, Department of Forensic Psychiatry, Kuopio, Finland
  • Professor, University of Helsinki, Department of Psychiatry, Helsinki, Finland

Academic degrees

  • MD, PhD

Group

Postdocs

  • Reseacher Markku Lähteenvuo, markku.lahteenvuo(at)niuva.fi

Technicians

  • Project manager Antti Tanskanen, antti.tanskanen(at)ki.se

Collaboration

  • Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden

Selected publications

Tiihonen J, Wahlbeck K, Lönnqvist J, Klaukka T, Ioannidis JPA, Volavka J, Haukka J. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ. 2006 Jul 29;333(7561):224.

Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Tanskanen A, Haukka J. Antidepressants and the risk of suicide, attempted suicide, and overall mortality in a nationwide cohort. Arch Gen Psychiatry. 2006 Dec;63(12):1358-67.

Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A, Haukka J. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet. 2009 Aug 22;374(9690):620-7.

Tiihonen J, Haukka J, Taylor M, Haddad PM, Patel MX, Korhonen P. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry. 2011 Jun;168(6):603-9.

Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P. Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Arch Gen Psychiatry. 2012 May;69(5):476-83.

Tiihonen J, Mittendorfer-Rutz E, Torniainen M, Alexanderson K, Tanskanen A: Mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines in patients with schizophrenia: an observational follow-up study. Am J Psychiatry. 2015 Dec 7:appiajp201515050618. [Epub ahead of print]