Causes of death in schizophrenia and manic-depression.

Department of Psychiatry, University of Oxford, Oxford, England, United Kingdom
The British Journal of Psychiatry (Impact Factor: 7.34). 04/1980; 136(MAR):239-42. DOI: 10.1192/bjp.136.3.239
Source: PubMed

ABSTRACT Causes of death were studied in a cohort of 200 schizophrenic, 100 manic, and 225 depressive patients who were followed in a historical prospective study. These patients were admitted between 1934 and 1944 and were studied 30 to 40 years later. Five cause of death categories were considered in this analysis: (1) unnatural deaths, (2) neoplasms, (3) diseases of the circulatory system, (4) infective and parasitic diseases, and (5) other causes. For each cause of death, the expected number of deaths was calculated from vital statistics for the State of Iowa for the time period of follow-up. Observed numbers of deaths were contrasted with expected numbers of deaths to assess statistical significance for each diagnostic group. There was a significant excess of unnatural deaths in all diagnostic groups in both sexes, with the exception of female manics. This group, however, did show a significant excess of circulatory system deaths. Both male and female schizophrenics showed a substantial excess of infective disorder deaths.

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    ABSTRACT: Even though individuals with psychiatric conditions have a prevalence of smoking approximately 2-4 times greater than the general population, surprisingly little evidence exists to inform an assessment of the full range of tobacco-related mortality in such populations. The current study aims to provide mortality estimates for conditions causally related to tobacco use among individuals hospitalized with a primary psychiatric diagnosis in California from 1990 to 2005. Restricting cases to those of individuals aged 35 or older at the mid-point of their follow-up period, we assembled cohorts of individuals with ICD-9 diagnoses of schizophrenia and related disorders ("schizophrenia"; n = 174,277), depressive disorders (n = 338,250), or bipolar disorder (n = 78,739). Inpatient records were linked to death-certificate data. We generated age-, sex-, and race-adjusted standardized mortality ratios (SMRs) for the 19 diseases identified by the Centers for Disease Control and Prevention as being causally linked to tobacco use. The SMRs for all tobacco-linked diseases combined were: schizophrenia, 2.45 (95% CI = 2.41-2.48); bipolar, 1.57 (95% CI = 1.53-1.62); and depression, 1.95 (95% CI = 1.93-1.98). Tobacco-related conditions comprised approximately 53% (23,620/44,469) of total deaths in the schizophrenia, 48% (6004/12,564) in the bipolar, and 50% (35,729/71,058) in the depression cohorts. Addressing tobacco use in psychiatric populations is a critical clinical and public-health concern, especially in light of the currently limited clinical attention devoted to tobacco use in these groups.
    Journal of Psychiatric Research 09/2013; 48(1). DOI:10.1016/j.jpsychires.2013.09.014 · 4.09 Impact Factor
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    ABSTRACT: IMPORTANCE There is concern that increased mortality risk among patients with psychiatric illness may be worsened by psychopharmacological agents. OBJECTIVES To assess mortality risk among adult patients with a diagnosis of schizophrenia, depression, bipolar disorder, anxiety disorders, or attention-deficit/hyperactivity disorder participating in clinical trials conducted by pharmaceutical companies for US Food and Drug Administration (FDA) approval to market and to evaluate if psychopharmacological agents worsen this risk. DATA SOURCES The FDA Summary Basis of Approval (SBA) reports of new drug applications and supplemental applications for 28 psychopharmacological agents approved between 1990 and 2011. STUDY SELECTION The FDA SBA reports detailing exposure data from acute placebo-controlled trials and safety extension studies including 92 542 patients from 47 adult drug approval programs for treatment of schizophrenia, depression, bipolar disorder, anxiety disorders, or attention-deficit/hyperactivity disorder and SBA reports on combination and maintenance therapy programs for treatments of bipolar disorder. DATA EXTRACTION AND SYNTHESIS We reviewed and synthesized mortality data from SBA reports that combined mortality rates across the clinical trials, including information on patient exposure years (PEY) for active treatments and placebo for individual indications. MAIN OUTCOMES AND MEASURES Overall mortality rate per 100 000 PEY in relation to the psychiatric diagnosis of the patients participating in psychopharmacology clinical trials. Also, the overall mortality rates using PEY technique among patients assigned to psychopharmacological agents or placebo were evaluated. RESULTS Overall, mortality risk was high and significantly associated with psychiatric diagnosis (χ24 = 1760; P < .001). Compared with the general adult population, patients with schizophrenia had the highest mortality risk (3.8-fold increase), followed by patients with depression (3.15-fold increase) and bipolar disorder (3.0-fold increase). The mortality risk was not increased when patients were assigned to psychotropic agents rather than placebo except for heterocyclic antidepressants. Suicide accounted for 109 of all 265 deaths (41.1%). CONCLUSIONS AND RELEVANCE These data suggest that increased mortality rates reported in population studies are detectable among adult patients with psychiatric illnesses participating in psychopharmacological trials. Furthermore, 3- to 4-month exposure to modern psychotropic agents, such as atypical antipsychotic agents, selective serotonin reuptake inhibitors, and selective serotonin-norepinephrine reuptake inhibitors does not worsen this risk. Given the inherent limitations of the FDA SBA reports, further research is needed to support firm conclusions.
    JAMA Psychiatry 08/2013; 70(10). DOI:10.1001/jamapsychiatry.2013.149 · 12.01 Impact Factor

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