Twenty-five year mortality of a community cohort with schizophrenia

Hampshire Partnership NHS Trust, Southampton, UK.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 02/2010; 196(2):116-21. DOI: 10.1192/bjp.bp.109.067512
Source: PubMed

ABSTRACT People with schizophrenia have significantly raised mortality but we do not know how these mortality patterns in the UK have changed since the 1990s.
To measure the 25-year mortality of people with schizophrenia with particular focus on changes over time.
Prospective record linkage study of the mortality of a community cohort of 370 people with schizophrenia.
The cohort had an all-cause standardised mortality ratio of 289 (95% CI 247-337). Most deaths were from the common causes seen in the general population. Unnatural deaths were concentrated in the first 5 years of follow-up. There was an indication that cardiovascular mortality may have increased relative to the general population (P = 0.053) over the course of the study.
People with schizophrenia have a mortality risk that is two to three times that of the general population. Most of the extra deaths are from natural causes. The apparent increase in cardiovascular mortality relative to the general population should be of concern to anyone with an interest in mental health.

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    • "People with schizophrenia have a mortality risk two to three times greater than the general population. Specifically, there is an apparent increase in cardiovascular mortality relative to the general population (Brown et al., 2010). People with schizophrenia also have a higher prevalence of risk factors for cardiovascular diseases (CVD) such as diabetes, metabolic syndrome, and obesity compared with the general population (Casey, 2005; Huang et al., 2009). "
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    ABSTRACT: Second-generation antipsychotics (SGAs) have been associated with an increased liability for weight gain and metabolic side effects. Among SGAs, clozapine and olanzapine had great liability to induce weight gain and metabolic adverse reactions. Leptin, adiponectin, and total ghrelin play important roles in energy homeostasis and are suggested to be biomarkers of metabolic disturbances. The purpose of the present study was to investigate the differential effects of antipsychotics (olanzapine and clozapine) on the levels of adipocytokines (leptin and adiponectin) and total ghrelin. Three hundred and thirty-three patients with schizophrenia under clozapine or olanzapine monotherapy were recruited. Control participants were recruited from a healthy community population based on a health investigation (N=119). Fasting blood samples for glucose, cholesterol, triglycerides, leptin, adiponectin, and total ghrelin were analyzed. There were significant differences in the levels of cholesterol, triglycerides, and glucose between these three groups. Post hoc comparisons showed that the olanzapine group had the highest levels of cholesterol and triglycerides. The levels of leptin, adiponectin, and total ghrelin were also significantly different between the three groups after controlling age and body mass index (BMI). Post hoc comparisons showed that the olanzapine group had the lowest levels of adiponectin and total ghrelin. The present study found that the uses of olanzapine and clozapine were associated with changes in adipocytokines and total ghrelin, even after adjusting potential confounding factors. Olanzapine had greater influences on adiponectin and total ghrelin than clozapine. The changes in adipocytokines and total ghrelin were a direct effect of antipsychotics on hormonal pathways of energy homeostasis, rather than the result of weight gain. Copyright © 2014. Published by Elsevier Inc.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 12/2014; 58. DOI:10.1016/j.pnpbp.2014.12.001 · 3.69 Impact Factor
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    • "These conditions may compromise medication compliance and the quality of life of patients with schizophrenia. Furthermore, life expectancy in schizophrenia is reduced, with an excess mortality that is two times higher than that in the general population,15,16 with cardiovascular diseases responsible for 50% of the excess mortality associated with schizophrenia diagnosis.17–22 "
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    ABSTRACT: Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.
    Neuropsychiatric Disease and Treatment 01/2014; 10:97-110. DOI:10.2147/NDT.S41063 · 1.74 Impact Factor
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    • "People with serious mental illnesses (SMIs) have a lower life expectancy than the rest of the population (Brown, Kim, Mitchell, & Inskip, 2010) and the gap in mortality may be increasing (Saha, Chant, & McGrath, 2007). Cardiovascular disease, diabetes, and other physical health problems are more common for people with SMI (Carney, Jones, & Woolson, 2006; Filik et al., 2006; Hardy & Thomas, 2012; Hultsjö & Hjelm, 2012; John, Koloth, Dragovic, & Lim, 2009; McCloughen, Foster, Huws-Thomas, & Delgado, 2012) and may account for earlier death (Brown, Inskip, & Barraclough, 2000; Brown et al., 2010; Vinogradova, Coupland, Hippisley-Cox, Whyte, & Penny, 2010). Increased physical health problems for people with SMI may be the outcome of social and economic factors (stigma, unemployment, poor housing), lifestyle behaviors (e.g., diet, sedentary behavior, and sleep) (Happell, Davies, & Scott, 2012; Scott & Happell, 2011), and intake of psychotropic medications (McCloughen & Foster, 2011; Park, Usher, & Foster, 2011; Rummel-Kluge et al., 2010; Tschoner et al., 2007). "
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    ABSTRACT: To identify how frequently nurses in mental health services communicate about physical health of consumers with other healthcare professionals, and whether such collaboration is associated with physical care actions with consumers. An online national Australian survey of nurses in mental health services. Nurses discuss physical health frequently with general practitioners, psychiatrists, and case managers, and less frequently with occupational therapists, social workers, and nurse practitioners. Interprofessional attention was positively associated with direct physical health care such as clinical screening and health education. Interprofessional communication may support nurses in direct physical healthcare actions with consumers. Increasing collaborations with nurse practitioners, social workers, and occupational therapists need to be explored as part of clinical teamwork development.
    Perspectives In Psychiatric Care 01/2014; 50(1):33-43. DOI:10.1111/ppc.12021 · 0.65 Impact Factor
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