An increased risk of stroke among young schizophrenia patients. Schizophrenia Research, 101(1-3), 234-241

School of Health Care Administration, Taipei Medical University, Taipei 110, Taiwan.
Schizophrenia Research (Impact Factor: 3.92). 04/2008; 101(1-3):234-41. DOI: 10.1016/j.schres.2007.12.485
Source: PubMed


This study sets out to estimate the risk of stroke developing among young schizophrenia patients during a five-year follow-up period after hospitalization for episodes of acute exacerbation.
Hospitalized schizophrenia patients under 45 years of age were identified from the Taiwan National Health Insurance Research Database for the year 1998 (n=5001). Two age-matched cases were randomly selected for each schizophrenia patient from among patients who underwent appendectomies in the same year (n=10,002). Each individual patient was retrospectively followed up from 1998 until the end of 2003 to determine whether any had developed strokes. Cox proportional hazard regressions were carried out to compute the adjusted five-year survival rate.
A total of 219 patients (1.46%) developed strokes during the five-year follow-up period, with the attacks occurring among 2.46% of schizophrenia patients and 0.94% of the comparison cohort. Following adjustment for patients' demographic characteristics, select comorbid medical disorders and substance abuse, schizophrenia patients were found to be 2.02 times (p<0.001) more likely to develop strokes during the follow-up period than age-matched appendectomy patients. The adjusted hazard ratios of developing stroke for male and female schizophrenia patients were, respectively, 1.64 (p<0.001) and 2.87 (p<0.001) times greater than their counterparts in the comparison group.
As compared with the comparison group, young schizophrenia patients demonstrated a two-fold increased risk of developing stroke during the five-year period after hospitalization. The risk of developing stroke among schizophrenia patients was found to be much higher for females than males.

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    • "Moreover, the TG of diabetes among schizophrenic patients remains quite high, reaching nontreatment rates around 40% in large-scale multicentric studies.35,36 The elevated prevalence of these metabolic problems may explain why the death rate from cardiovascular disorders in schizophrenic patients has not declined in recent years in developed countries, as it has in the general population, and stands as the first cause of mortality among patients with SMD.18,37 Patients with schizophrenia and other SMD are at greater risk of coronary heart diseases,19 stroke,38 ventricular arrhythmias,39 and sudden death.40 Given that the excess of cardiovascular mortality is, at least partially, a result of modifiable risk factors (lack of exercise, obesity, smoking), there is a need to improve the access of schizophrenic patients to primary care facilities, where these issues can be evaluated and monitored first-hand. "
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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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    • "Individuals with appendicitis served as the population-proxy comparison group, given that appendicitis: 1) is a relatively frequent reason for admission to hospital; 2) does not appear to be related to PD, alcohol use disorders or other drug disorders; 3) has been used successfully as a population-proxy reference group in other studies [10]; and 4) groups drawn from inpatient medical records have shown to have an incidence of PD not different from that of the general population [11]. Inclusion criteria for this cohort consisted of: 1) a diagnosis of an appendicitis-related condition at their index admission (ICD-8 or ICD-9 codes 540–542; or ICD-10 codes K35-K37 identified by the main and up to seven contributory diagnoses); 2) no prior, concurrent, or subsequent indication of any alcohol- or other drug-use diagnoses. "
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    ABSTRACT: Alcohol has been suggested to be either protective of, or not associated with Parkinson's disease (PD). However, experimental animal studies indicate that chronic heavy alcohol consumption may have dopamine neurotoxic effects relevant for PD. We studied the association between diagnosed alcohol use disorders and PD. All individuals in Sweden admitted with a diagnosis of an alcohol use disorder or appendicitis (reference group) between January 1, 1972 and December 31, 2008 were identified through the Swedish National Inpatient Register, and followed for up to 37 years for a diagnosis of PD. We estimated hazard ratios (HR) with 95% confidence intervals (CI) and adjusted for age and sex. We found 1 741 (0.3%) cases of PD in the cohort of 602 930 individuals, 1 083 (0.4%) among those admitted with an alcohol use disorder and 658 (0.2%) of the individuals admitted with appendicitis. The mean follow-up time was 13.6 and 17.1 years, respectively. The HR for PD associated with an alcohol use disorder was 1.38 (CI 1.25-1.53) adjusted for age and sex. When the risk was estimated in age groups for first hospital admission with PD the highest risk was observed in the lowest age group, <=44, HR 2.39 (0.96-5.93), adjusted for age at exposure and sex. A history of an alcohol use disorder conferred an increased risk of admission with a diagnosis of Parkinson's disease in both women and men. In particular, the risk seemed higher at lower ages of first admission with Parkinson's disease.
    BMC Neurology 12/2013; 13(1):190. DOI:10.1186/1471-2377-13-190 · 2.04 Impact Factor
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    • "Two previous studies have used the Taiwan National Health Insurance Research Database (NHIRD) admission data to study patients with schizophrenia. One study reported a higher incidence of stroke among patients who were less than 45 years of age (Lin et al., 2008), and the other study reported a lower mortality rate among stroke patients during a 90-day follow-up period (Kang et al., 2011). However, these studies did not utilize outpatient data; therefore, the results may have excluded patients with less severe schizophrenia (or stroke, or both), limiting their generalizability. "
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    ABSTRACT: This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality in patients with schizophrenia. This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 80,569 patients with schizophrenia and 241,707 age- and sex-matched control participants without schizophrenia. The participants were randomly selected from the 23,981,020-participant NHIRD, which consists of 96% Taiwanese participants. Participants who had experienced a stroke between 1999 and 2003 were excluded. Using data from the NHIRD between 2004 and 2008, the incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups. After adjusting for confounding risk factors, a Cox proportional-hazards model was used to compare the five-year stroke-free survival rate to the all-cause mortality rate across the two cohorts. Over five years, 1380 (1.71%) patients with schizophrenia and 2954 (1.22%) controls suffered from strokes. After adjusting for demographic characteristics and comorbid medical conditions, patients with schizophrenia were 1.13 times more likely to have a stroke (95% CI=1.05-1.22; P=0.0006). In addition, 1039 (24%) patients who had a stroke died during the follow-up period. After adjusting for patient, physician and hospital variables, the all-cause mortality hazard ratio for patients with schizophrenia was 1.23 (95% CI=1.06-1.41; P=0.0052). During a five-year follow-up, the likelihood of developing a stroke and the all-cause mortality rate were greater among patients with schizophrenia as compared with the control group.
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