Ulla Lång, Ph.D., Johanna Metsälä, Ph.D., Hugh Ramsay, Ph.D., M.D., Fiona Boland, Ph.D., Katriina Heikkilä, Ph.D., Anna Pulakka, Ph.D., Anne Lawlor, M.A., Karen O’Connor, M.D., Juha Veijola, Ph.D., M.D., Eero Kajantie, Ph.D., M.D., Colm Healy, Ph.D., and Ian Kelleher, Ph.D., M.D.
Paywalled
Objective:
As many as half of individuals who develop psychosis had attended child and adolescent psychiatric services at some stage in childhood, highlighting substantial opportunities for prevention within these services if an effective preventive intervention were identified. The authors hypothesized that adolescent psychiatric patients exposed to doxycycline, an antibiotic with putative neuroprotective properties, would have a lower risk of developing schizophrenia.
Methods:
This was an emulated target trial using nationwide Finnish health register data on all individuals born between 1987 and 1997 who attended adolescent psychiatric services between ages 13 and 18 and had used any antibiotics. Individuals were followed from first dispensed antibiotic prescription up to age 30. The main outcome was recorded schizophrenia diagnosis. The g-formula was used to estimate schizophrenia risk across doxycycline exposure levels (cumulative dose doxycycline use: no doxycycline use; low use, <1,499 mg; medium use, 1,500–2,999 mg; high use, ≥3,000 mg) during different follow-up periods.
Results:
A total of 56,395 individuals had attended adolescent psychiatric services and had used antibiotics; of these, 16,189 (28.7%) had used doxycycline. The risk of schizophrenia after 10 years of follow-up was 2.1% (95% CI=1.9, 2.3) for individuals who had used non-doxycycline antibiotics. In comparison, the risk of schizophrenia at 10 years was significantly lower in adolescent psychiatric patients treated with doxycycline (low cumulative dose: 1.4%, risk ratio=0.70, 95% CI=0.48, 0.85; medium cumulative dose: 1.4%, risk ratio=0.65, 95% CI=0.25, 1.04; high cumulative dose: 1.5%, risk ratio=0.70, 95% CI=0.43, 0.97).
Conclusions:
These findings raise the tentative but exciting possibility that doxycycline treatment may reduce schizophrenia risk in adolescent psychiatric patients.
I don’t know what the g-formula is and haven’t looked at paper yet
But it seems they followed those who had that antibiotic from their first prescription to see how many ended up diagnosed with schizophrenia
Then rather than having controls used a calculation to compare it to likelihood of it in I guess the general population
I know Finnish schools are now very good so I guess there is the possibility their system is one of the few without gaps in records that Uk stuff would be full of and massive variation in care due to GP system and other elements of the health system so ‘maybe’ could theoretically look into but assume all under psychiatric care are actually getting decent follow up there and other decent care
But that’s where it feels the flaw is - the less ill you are or other factors in your life that might be associated with schizophrenia anyway (like organised home, stress, support system) the more likely you are perhaps to get antibiotics when you have something that could do with it vs if you don’t have those things going for you ie confounding factors.
I don’t know how theoretically good a Finnish system is for managing to control for all these or how good is the equality in their medical care system and the surrounding aspects like school and school nurses ebduring less dropping thru the net or needing an assertive knowledgeable not busy parent to get such things. Can they be sure it’s not a proxy that those who got care for the smaller things rather than the antibiotic itself?
I guess it depends on the size of effect and being convinced of knowing more about the systems over there.
I’m guessing the authors are at least open to the possibility too that just a few who perhaps had some infection that could have done with timely treatment and never got it being a possibility in tipping the difference between those who mightnt have progressed into schizophrenia could be there too?
Either way it’s interesting particularly if there is particularly good ongoing psych care that took notes so might put meat on the bones if they picked up on people who had things that perhaps weren’t treated
It’s an interesting one because this and similar antibiotics have a risk of teeth staining, more so if taken a lot and it’s black lines and greying that can be permanent type stuff (not just remove it by x stuff) due to binding with the calcium in those unlucky enough to be susceptible - you have to keep an eye on it
So there is just a chance that some got switched to other types due to that side effect or risk as it seems adolescence is a bad time for it as teeth are developing too
So you might just have - ‘if’ everyone with similar ailments was getting treated and just some got another antibiotic - the chance of a bit of a control group if it was done that way
Albeit who knows if whatever stops you being unlucky with the teeth staining has any connection at all
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