Mortality in first-contact psychosis patients in the UK: A cohort study

Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
Psychological Medicine (Impact Factor: 5.94). 12/2011; 42(8):1649-61. DOI: 10.1017/S0033291711002807
Source: PubMed


The excess mortality following first-contact psychosis is well recognized. However, the causes of death in a complete incidence cohort and mortality patterns over time compared with the general population are unknown.
All 2723 patients who presented for the first time with psychosis in three defined catchment areas of the U.K. in London (1965-2004, n=2056), Nottingham (1997-1999, n=203) and Dumfries and Galloway (1979-1998, n=464) were traced after a mean of 11.5 years follow-up and death certificates were obtained. Data analysis was by indirect standardization.
The overall standardized mortality ratio (SMR) for first-contact psychosis was 184 [95% confidence interval (CI) 167-202]. Most deaths (84.2%, 374/444) were from natural causes, although suicide had the highest SMR (1165, 95% CI 873-1524). Diseases of the respiratory system and infectious diseases had the highest SMR of the natural causes of death (232, 95% CI 183-291). The risk of death from diseases of the circulatory system was also elevated compared with the general population (SMR 139, 95% CI 117-164) whereas there was no such difference for neoplasms (SMR 111, 95% CI 86-141). There was strong evidence that the mortality gap compared with the general population for all causes of death (p<0.001) and all natural causes (p=0.01) increased over the four decades of the study. There was weak evidence that cardiovascular deaths may be increasing relative to the general population (p=0.07).
People with first-contact psychosis have an overall mortality risk that is nearly double that of the general population. Most excess deaths are from natural causes. The widening of the mortality gap over the last four decades should be of concern to all clinicians involved in delivering healthcare.

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Available from: Rina Dutta, May 08, 2014
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    • "Life expectancy has risen in developed countries over the last few decades (WHO, 2014) but recent estimates suggest that people with schizophrenia, as well as other psychotic disorders, die 15 to 20 years earlier than their peers (Beary et al., 2012; Crump et al., 2013; Hoang et al., 2013; Hoang et al., 2011; Laursen et al., 2014; Nielsen et al., 2013; Saha et al., 2007; Wahlbeck et al., 2011). The reasons for this disparity are unclear (Dutta et al., 2012; Hoang et al., 2013; Hoang et al., 2011; Koivisto et al., 2002; Rantanen et al., 2009; Saha et al., 2007) and it remains a major public health concern (Reininghaus et al., 2014; Tiihonen et al., 2009; van Os et al., 1997). Recent attempts to unravel clinical and social factors associated with excess mortality in this population suggest that lifestyle , side effects of antipsychotic drug treatment and factors associated "
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    ABSTRACT: It has long been held that schizophrenia and other psychotic disorders have a predominately poor course and outcome. We have synthesized information on mortality, clinical and social outcomes from the ÆSOP-10 multicenter study, a 10-year follow-up of a large epidemiologically characterized cohort of 557 people with first-episode psychosis. Symptomatic remission and recovery were more common than previously believed. Distinguishing between symptom and social recovery is important given the disparity between these; even when symptomatic recovery occurs social inclusion may remain elusive. Multiple factors were associated with an increased risk of mortality, but unnatural death was reduced by 90% when there was full family involvement at first contact compared with those without family involvement. These results suggest that researchers, clinicians and those affected by psychosis should countenance a much more optimistic view of symptomatic outcome than was assumed when these conditions were first described.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    The Journal of nervous and mental disease 04/2015; 203(5). DOI:10.1097/NMD.0000000000000295 · 1.69 Impact Factor
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    • "Previous research finds those with SMI at greater risk of mortality than unaffected individuals, not accounted for by excess suicide [3,8]. Recent large scale population based studies find much of this excess mortality to be associated with preventable physical health problems, including cardiovascular diseases and cancer [2,4,8], as well as diabetes mellitus [2,22], infectious and respiratory diseases [2,8]. "
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    ABSTRACT: Background Serious mental illness (SMI) is associated with elevated mortality compared to the general population; the majority of this excess is attributable to co-occurring common physical health conditions. There may be variation within the SMI group in the distribution of physical co/multi-morbidity. This study aims to a) compare the pattern of physical co- and multi-morbidity between patients with and without SMI within a South London primary care population; and, b) to explore socio-demographic and health risk factors associated with excess physical morbidity among the SMI group. Methods Data were obtained from Lambeth DataNet, a database of electronic patient records derived from general practices in the London borough of Lambeth. The pattern of 12 co-morbid common physical conditions was compared by SMI status. Multivariate ordinal and logistic regression analyses were conducted to assess the strength of association between each condition and SMI status; adjustments were made for potentially confounding socio-demographic characteristics and for potentially mediating health risk factors. Results While SMI patients were more frequently recorded with all 12 physical conditions than non-SMI patients, the pattern of co-/multi-morbidity was similar between the two groups. Adjustment for socio-demographic characteristics – in particular age and, to a lesser extent ethnicity, considerably reduced effect sizes and accounted for some of the associations, though several conditions remained strongly associated with SMI status. Evidence for mediation by health risk factors, in particular BMI, was supported. Conclusions SMI patients are at an elevated risk of a range of physical health conditions than non-SMI patients but they do not appear to experience a different pattern of co-/multimorbidity among those conditions considered. Socio-demographic differences between the two groups account for some of the excess in morbidity and known health risk factors are likely to mediate the association. Further work to examine a wider range of conditions and health risk factors would help determine the extent of excess mortality attributable to these factors.
    BMC Family Practice 06/2014; 15(1):117. DOI:10.1186/1471-2296-15-117 · 1.67 Impact Factor
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    ABSTRACT: Objective: Attempted suicide and deliberate self-injury can occur before or after presentation with a first-episode of psychosis. The aim of the study is to identify the factors associated with suicide attempts or deliberate self-injury before and after treatment for first-episode psychosis. Method: A systematic review and meta-analysis of controlled studies of factors associated with either suicide attempts or deliberate self-injury, referred to here as deliberate self-harm (DSH). Results: The pooled proportion of patients who reported DSH prior to treatment for first-episode psychosis was 18.4% (95% Confidence Interval (CI) 14.4-23.3, N = 18 studies, I(2) = 93.8). The pooled proportion of patients with DSH during the period of untreated psychosis was 9.8%, (95% CI 6.7-14.2, N = 5 studies, I(2) = 58.9). The pooled proportion of patients committing DSH during periods of follow up of between 1 and 7 years was 11.4%, (95% CI, 8.3-15.5, N = 13 studies, I(2) = 89.2). Categorical factors associated with an increased risk of DSH were a prior history of DSH (OR = 3.94), expressed suicide ideation (OR = 2.34), greater insight (OR = 1.64), alcohol abuse (OR = 1.68) and substance use (OR = 1.46). Continuous variables associated with an increased risk of DSH were younger age of onset (Standardized Mean Difference (SMD) = -0.28), younger age at first treatment (SMD = -0.18), depressed mood (SMD = 0.49) and the duration of untreated psychosis (SMD = 0.20). Depressed mood and substance use were associated with DSH both before and after treatment, negative symptoms were associated with DSH after treatment but not before treatment. Positive symptoms and social and global functioning were not associated with DSH. Younger age and the duration of untreated psychosis were associated with DSH before treatment but not after treatment. Conclusion: Earlier treatment of first-episode psychosis and successful treatment of depression and substance use could prevent some episodes of DSH and might reduce suicide mortality in early psychosis.
    Acta Psychiatrica Scandinavica 01/2013; 127(6). DOI:10.1111/acps.12074 · 5.61 Impact Factor
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