National estimates of adverse events during nonpsychiatric hospitalizations for persons with schizophrenia.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
General hospital psychiatry (Impact Factor: 2.67). 07/2010; 32(4):419-25. DOI: 10.1016/j.genhosppsych.2010.04.006
Source: PubMed

ABSTRACT Persons with schizophrenia comprise a vulnerable population that may be disproportionately susceptible to medical injuries. The objective of this study was to determine the association between diagnosis of schizophrenia and adverse events during non-psychiatric hospitalizations.
We studied U.S. hospital discharges from 2002-2007 using the Nationwide Inpatient Sample. We determined the nationally weighted association of schizophrenia with the Agency for Healthcare Research and Quality's Patient Safety Indicators after adjusting for patient, hospitalization, and hospital characteristics.
There were 269,387 non-psychiatric hospitalizations with schizophrenia, and 37,092,651 without. Hospitalizations with schizophrenia had elevated adjusted odds ratios for PSIs compared with those without schizophrenia for decubitus ulcer (1.43, 95% CI: 1.36-1.51); infection from medical care (1.19, 95% CI: 1.08-1.30); postoperative respiratory failure (1.96, 95% CI: 1.67-2.30); sepsis (1.59, 95% CI: 1.25-2.02); and pulmonary embolism/deep venous thrombosis (1.23, 95% CI: 1.13-1.35). Adjusted odds ratios for iatrogenic pneumothorax (1.12, 95% CI: 0.94-1.33) and postoperative hemorrhage (1.07, 95% CI: 0.88-1.31) were not significantly different in persons with schizophrenia, while the adjusted OR for accidental puncture (OR=0.66, 95% CI: 0.58-0.74) was reduced in persons with schizophrenia.
Persons with schizophrenia are more likely to experience the most common types of medical injuries. Improved understanding of factors related to hospital quality of care and outcomes in this group will be important to plan interventions to enhance patient safety for persons with schizophrenia.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Schizophrenia and bipolar disorder are debilitating disorders. In addition to classic psychotic and mood symptoms, frequency of cognitive disturbances and mortality from cardiovascular disease are high. Inflammation has been associated with both cognitive disturbances and cardiovascular disease. Recent studies have indicated increased inflammation in patients with severe mental disorders. However, these studies are small and have a limited number of inflammatory markers. This makes it difficult to draw any conclusions about the mechanisms involved. No studies have investigated if inflammatory disturbances differ between schizophrenia and bipolar disorder. Inflammation has been associated with depression and mania, but it is still unclear how it relates to mood symptoms and affective states. Aims: The aims were to determine if patients with severe mental disorder have high levels of inflammation, if they have a specific inflammatory profile, if inflammatory disturbances differ between schizophrenia and bipolar disorder patients, and if inflammatory profile is associated with mood symptoms or affective state. Methods: 312 patients from a catchment area were included together with 239 healthy controls. Patients were diagnosed according to DSM-V, and degree of depression and mania was assessed with standard instruments. Four general inflammatory markers were measured: Tumor necrosis factor receptor 1 (TNF-R1), Interleukin 1 receptor antagonist (IL-1Ra), Interleukin 6 (IL-6) and high-sensitivity CRP (hs- CRP). Three specific markers were measured: The platelet related inflammatory marker CD40L ligand (sCD40L), the endothelial related marker von Willebrand factor (vWf) and the calcium related inflammatory marker Osteoprotegerin (OPG). Routine biochemical blood tests and clinical characteristics, which could confound associations, were also assessed. Results: Patients had a similar immune profile with highly significant increase of TNF-R1, vWf and OPG (p<0.000002, p<0.000002, and p=0.01 respectively). The results were significant also after control for confounding factors. Contrary to expectations, depressed bipolar disorder patients had the lowest levels of inflammation and manic patients had the highest. Degree of depressive mood was also inversely correlated with inflammation, which was significant for OPG (p=0.0003), IL-1Ra (p=0.001) and IL-6 (p= 0.002). Patients in manic state had significantly higher levels of OPG, vWf, IL-1Ra and sTNF-R1. There were no associations between mood and inflammation in schizophrenia. Discussion: The study indicated that the general inflammatory marker TN-R1, as well as endothelial and calcium related inflammation may play a role in severe mental illness pathology. TNF-R1 has been found to be involved in neuronal plasticity, and related to cognitive dysfunction, which is an important clinical characteristic of the disorders. The results are also in line with recent findings that endothelial dysfunction and calcium metabolism are involved in the pathology. Furthermore, OPG and vWf are risk factors of cardiovascular disease and the high levels in patients may be related to their elevated mortality rates. It has been fairly well documented that inflammation induces typical sickness behavior, with reduced energy, increased sleep and depressive mood. Therefore, it was unexpected that inflammation was increased in the manic state. This suggests that there may be other inflammatory mechanisms involved. Conclusions: Both bipolar disorder and schizophrenia show increased TNF-R1, OPG and vWf. This immune profile suggests inflammatory disturbances related to neuroplasticity, endothelial function and calcium regulation. In bipolar disorder patients, elevated mood is characterized by high levels of inflammation, while depressed mood is characterized by low. This suggests that inflammatory disturbances may be involved with core psychopathology of bipolar disorder. The study supports that inflammatory disturbances are of importance in severe mental disorders.
    04/2012, Degree: PhD, Supervisor: Ole A Andressen
  • General Hospital Psychiatry 11/2010; 32(6):644-644. · 2.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several risk factors of venous thromboembolism (VTE) and pulmonary embolism (PE) were found in patients with schizophrenia. Therefore, we hypothesize that the incidences of VTE and PE are relatively higher among schizophrenia patients in comparison with the general population. For this population-based cohort study, claims data from 1996 to 2011 were obtained from the National Health Insurance Research Database in Taiwan. We compared the incidence of DVT and PE between schizophrenia and non-schizophrenia cohorts. Cox proportional hazard regression models were used to analyze the risk of DVT and PE, according to sex, age, and comorbidities. Compared with the non-schizophrenia cohort, the schizophrenia cohort exhibited a 2.02-fold higher adjusted hazard ratio (HR) for developing DVT, and a 1.99-fold higher adjusted HR for developing PE. Furthermore, schizophrenia patients using first-generation or second-generation antipsychotics exhibited a higher adjusted HR for both DVT and PE development. Compared with the general population, the risk of DVT and PE is relatively higher among schizophrenia patients. Early diagnosis and intervention by physicians could mitigate complications and reduce mortality resulting from VTE. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 01/2015; · 4.43 Impact Factor

Full-text (2 Sources)

Available from
Jun 2, 2014