{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T19:10:19Z","timestamp":1783019419656,"version":"3.54.6"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,12,25]],"date-time":"2020-12-25T00:00:00Z","timestamp":1608854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the mortality in people using clozapine to that of people using other antipsychotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Danish incidence cohort of 22,110 patients with a first diagnosis of non\u2010affective psychotic disorder (1995\u20132013) and a prevalence cohort of 50,881 patients ever diagnosed with such a disorder (1969\u20132013). Hazard ratios (HR) were calculated for the antipsychotic drug used at the time of death (\u201ccurrent use\u201d: incidence and prevalence cohort) and for the drug used for the longest at that moment (\u201ccumulative use\u201d: incidence cohort), using a Cox model with adjustment for somatic comorbidity. Clozapine was the reference drug.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>As for current drug use, the risk of suicide was higher among users of other antipsychotics in the incidence (HR<jats:sub>adj<\/jats:sub>\u00a0=\u00a01.76; 95% CI 0.72\u20134.32) and prevalence (HR<jats:sub>adj<\/jats:sub>\u00a0=\u00a02.20; 95% CI 1.35\u20133.59) cohorts. There was no significant difference in all\u2010cause or cardiovascular mortality in the two cohorts. Cumulative use of clozapine was not associated with an increased cardiovascular mortality. Cumulative use of other antipsychotics for up to 1\u00a0year was associated with a lower all\u2010cause mortality and suicide risk than a similar period of clozapine use (all\u2010cause: HR<jats:sub>adj<\/jats:sub>\u00a0=\u00a00.73; 95% CI 0.63\u20130.85, suicide; HR<jats:sub>adj<\/jats:sub>\u00a0=\u00a00.65; 95% CI 0.46\u20130.91).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results indicate that the use of clozapine is not associated with increased cardiovascular mortality. We found opposing trends toward a lower risk of suicide during current use of clozapine and a higher risk of suicide associated with cumulative use up to 1\u00a0year. This suggests that clozapine cessation marks a period of high risk of suicide.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acps.13267","type":"journal-article","created":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T16:24:06Z","timestamp":1607703846000},"page":"216-226","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study"],"prefix":"10.1111","volume":"143","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1332-5712","authenticated-orcid":false,"given":"Yvonne","family":"van der Zalm","sequence":"first","affiliation":[{"name":"Rivierduinen Institute for Mental Health Leiden The Netherlands"},{"name":"Deptartment of Psychiatry &amp; Neuropsychology School for Mental Health and Neuroscience Maastricht University Medical Center Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Foldager","sequence":"additional","affiliation":[{"name":"Department of Animal Science Aarhus University Tjele Denmark"},{"name":"Bioinformatics Research Centre Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Termorshuizen","sequence":"additional","affiliation":[{"name":"Rivierduinen Institute for Mental Health Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris E.","family":"Sommer","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Department of Psychiatry University Medical Center Groningen Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmi","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Mental Health Centre Glostrup Mental Health Services University of Copenhagen Glostrup Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Paul","family":"Selten","sequence":"additional","affiliation":[{"name":"Rivierduinen Institute for Mental Health Leiden The Netherlands"},{"name":"Deptartment of Psychiatry &amp; 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