The unchanging mortality gap for people with schizophrenia

Department of Psychiatry, Yale School of Medicine, New Haven, CT 06508, USA.
The Lancet (Impact Factor: 45.22). 08/2009; 374(9690):590-2. DOI: 10.1016/S0140-6736(09)61072-2
Source: PubMed
3 Reads
    • "On the other hand, the drugs used to manage schizophrenics, though beneficial, have been reported to produce certain side effects such as considerable weight gain, diabetes, and risk of metabolic syndrome.[28 ] Some atypicals such as quetiapine and risperidone are associated with a higher risk of death compared to the atypical perphenazine, while clozapine is associated with the lowest risk of death.[29] It remains unclear whether the newer antipsychotics reduce the chances of developing neuroleptic malignant syndrome, a rare but serious neurological disorder.[30] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Schizophrenia is a psychosis characterized by delusions and hallucinations occurring in clear consciousness. Studies have shown that the cytokines may modulate dopaminergic metabolism and schizophrenic symptomatology in schizophrenia. Cytokine involvement in periodontal disease is also well documented. To date, however, there has been relatively little research assessing periodontal status of patients with schizophrenia. The present study was therefore mainly intended to understand the exact link, if any, between periodontal disease and schizophrenia. A total of 250 schizophrenic patients (140 males and 110 females), between 25 and 55 years of age, were selected from the out patient department of National Institute of Mental Health and Neural Sciences, Bangalore and their periodontal status was assessed as part of this cross-sectional epidemiological survey. ANOVA showed that there was increased evidence of poor periodontal condition, as evidenced by gingival index and plaque index in patients who had been schizophrenic for a longer duration of time (P < 0.001). So also, higher probing pocket depths were found in schizophrenics suffering from a longer period of time than others (P < 0.001). Although oral neglect might be a cause of poor periodontal health in schizophrenics, the possible link between periodontal diseases giving rise to schizophrenia cannot be overlooked due to the presence of cytokine activity which is present both in schizophrenia and periodontal disease.
    Journal of Indian Society of Periodontology 03/2014; 18(1):69-73. DOI:10.4103/0972-124X.128222
  • Source
    • "Obesity is a growing health problem leading to high rates of mortality and morbidity in patients with severe mental illness (SMI) [1-4]. Studies demonstrate the prevalence of obesity and related diseases are much higher in patients with SMI than in general population [2,5-7]. It was found that 42% of individuals with schizophrenia had a Body Mass Index (BMI) of 27 or greater, compared to 27% of the general population [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity is a growing health problem leading to high rates of mortality and morbidity in patients with severe mental illness (SMI). The increased rate of obesity is largely attributed to antipsychotic use. The effect of antipsychotic medications on H1 and 5HT2 receptors has been associated with weight gain, but there is also a substantial amount of evidence showing that D2 receptor blockade may be responsible for weight gain by interacting with the dopamine-opioid system. Unfortunately, current available medications for weight loss have limited efficacy in this population. Naltrexone, an opioid receptor antagonist, may be a promising agent to reduce antipsychotic induced weight gain by decreasing food cravings. We aim to investigate the safety and efficacy of two doses of naltrexone (25mg & 50mg) versus placebo for weight and health risk reduction in overweight and obese individuals (BMI >= 28) with SMI, who gained weight while being treated with antipsychotics.Methods and design: One hundred and forty four patients will be recruited throughout the greater New Haven area. The participants will be randomized to naltrexone 25mg/day, naltrexone 50mg/day, or placebo in a 1:1:1 ratio. Participants will be on the study medication for 52 weeks, and assessed weekly for the first 4 weeks and bi-weekly thereafter. The primary outcome measurements are weight reduction and percentage achieving clinically significant weight loss (5% of total body weight). Waist circumference, body mass index, serum lipid profile, fasting glucose, and glycosylated hemoglobin are the secondary outcome measures. The effect of naltrexone on other outcome measurements such as schizophrenia symptoms, depression, dietary consumption, quality of life, cognitive functioning, physical activity, metabolism/inflammation markers, serum leptin, ghrelin, peptide YY, adinopectin, high sensitivity CRP, interleukin 6, interleukin-1B, interleukin-18, and tumor necrosis factor alpha (TNF-alpha) will be evaluated. The data will be analyzed by applying linear mixed effect models. This is the first large scale study investigating the safety and efficacy of naltrexone in antipsychotic induced weight gain; and hopefully, this may lead to a novel pharmacological option for management of this major health problem.Trial registration: This trial is registered in as NCT01866098.
    BMC Psychiatry 06/2013; 13(1):176. DOI:10.1186/1471-244X-13-176 · 2.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates.
    World psychiatry: official journal of the World Psychiatric Association (WPA) 06/2010; 9(2):67-77. DOI:10.1002/j.2051-5545.2010.tb00276.x · 14.23 Impact Factor
Show more