An Outcome Measure in Schizophrenia: Mortality

Seeman, Mary V.

doi:10.1177/070674370705200109

Cited by 25 publications

(11 citation statements)

References 47 publications

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“…One exception is China, where the suicide rates for men and women are equal, or even higher for women [90]. In general, the suicide rate is approximately three-to four-times higher for men than for women [45,[90][91][92]. The gender difference seems to be less marked among patients with schizophrenia.…”

Section: Gender and Suicide Risk In Schizophreniamentioning

confidence: 97%

“…During the last few decades there have been changes in health systems, with significant reductions in in-patient capacity. These changes have been suspected to be an important factor in the rising mortality seen in patients with schizophrenia [44,45]. However, the effect of the reduction in in-patient capacity on the suicide rate remains unclear due to conflicting results [46].…”

Section: Reviewmentioning

confidence: 99%

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Suicide in schizophrenia

Carlborg

Winnerbäck

Jönsson

et al. 2010

Expert Review of Neurotherapeutics

113

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SchizophreniaSchizophrenia is a devastating psychiatric disorder affecting approximately 1% of the population worldwide during a lifetime. The onset of the illness occurs relatively early in life, usually in the late teens or early adulthood, and most patients have long-lasting adverse effects. Schizophrenia is a clinical syndrome diagnosed on the basis of symptom profiles, and is characterized by a constellation of symptoms of psychosis, such as abnormalities in the perception or expression of reality, as well as negative symptoms, such as affective flattening and avolition. Cognitive deficits are also usually present, and the symptoms must have persisted continuously for a least 6 months: however, schizophrenia cannot be diagnosed if symptoms of mood disorder are present or the symptoms are the direct result of a medical condition or substance abuse (Box 1) [201].The specific causes of schizophrenia are not known and combinations of several factors are likely to be involved. Genetic factors play a major role in the development of the disease [1], and environmental factors are also of importance. These latter factors include a history of obstetric complications, such as asphyxia [2] and prematurity [3]. Advanced paternal age is also considered to be a risk factor [4], and birth during the spring and late winter also increases the risk [5]. Prenatal viral infections [6], serious viral infections of the CNS during childhood [7], migrant status and urban rearing [8], and a lifetime history of cannabis use [9] are other well-known risk factors.Contrary to previous interpretations, the incidence and prevalence of schizophrenia show marked variation between sites. For example, migrants have an increased incidence and prevalence of schizophrenia, and exposures related to urbanicity, economic status and latitude are also associated with various frequency measures [10]. Men have a higher risk than women [11], and a recent review concluded that men have a 40% higher incidence of schizophrenia than women [12]. SuicideSuicide is defined as a self-inflicted death with evidence that the person intended to die (Box 2) [13]. Suicide is among the leading causes of premature death in the world and it is estimated that approximately 1 million people die by suicide every year [202]. Suicide rates vary according to region, gender, age, time and ethnic origin, and also according to death registration practices. The annual suicide rate in the world is 14.5 out of 10,0000 (in 2000), which is equal to one suicide every 40 s. Suicide is approximately three-to four-times more common in men than in women [202]. Suicide rates vary between different regions, and underestimation of suicide rates is common due to under-reporting, lack of epidemiological data and misclassification [14]. It has been estimated from psychological autopsies that more than 90% of those dying by suicide have a diagnosable psychiatric disorder at the time of death, and approximately 60% of the Schizophrenia is a disorder with an estimated suicide risk of 4-5%. Many f...

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Section: Gender and Suicide Risk In Schizophreniamentioning

confidence: 97%

Section: Reviewmentioning

confidence: 99%

Suicide in schizophrenia

Carlborg

Winnerbäck

Jönsson

et al. 2010

Expert Review of Neurotherapeutics

113

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“…Mortality is increasingly recognized as a crucial outcome measure for quality of care patients with schizophrenia receive [2,3]. Several studies reported that people with schizophrenia live shorter lives compared with the general population [4].…”

Section: Introductionmentioning

confidence: 99%

Five-year mortality in a cohort of people with schizophrenia in Ethiopia

et al. 2011

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BackgroundSchizophrenia is associated with a two to three fold excess mortality. Both natural and unnatural causes were reported. However, there is dearth of evidence from low and middle income (LAMIC) countries, particularly in Africa. To our knowledge this is the first community based report from Africa.MethodsWe followed a cohort of 307 (82.1% males) patients with schizophrenia for five years in Butajira, rural Ethiopia. Mortality was recorded using broad rating schedule as well as verbal autopsy. Standardized Mortality Ratio (SMR) was calculated using the mortality in the demographic and surveillance site as a reference.ResultThirty eight (12.4%) patients, 34 men (11.1%) and 4 women (1.3%), died during the five-year follow up period. The mean age (SD) of the deceased for both sexes was 35 (7.35). The difference was not statistically significant (p = 0.69). It was 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to7.87). Rural residents had lower mortality with adjusted hazard ratio (HR) of 0.30 (95% CI = 0.12-0.69) but insidious onset and antipsychotic treatment for less than 50% of the follow up period were associated with higher mortality, adjusted HR 2.37 (95% CI = 1.04-5. 41) and 2.66(1.054-6.72) respectively.ConclusionThe alarmingly high mortality observed in this patient population is of major concern. Most patients died from potentially treatable conditions. Improving medical and psychiatric care as well as provision of basic needs is recommended.

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“…Among these metabolic syndrome, already a concern in persons with schizophrenia based on life style risk factors, is a major concern with drugs that cause increased body mass index, hyperlipidemia, reduced insulin sensitivity, and are associated with an increased incidence of diabetes. Reduction in life span is great, and expected to worsen with increased exposure to pharmacological adverse effects (Hennekens et al, 2005;Auquier et al, 2006;Seeman, 2007;Colton and Manderscheid, 2006;Newcomer and Hennekens, 2007). In most respects, drug development for schizophrenia has not progressed appreciably since the introduction of chlorpromazine, a point which recently found emphasis in a large first episode clinical trial in Beijing comparing the original antipsychotic drug, chlorpromazine, with the only second generation drug with documented superiority, clozapine.…”

Section: Introductionmentioning

confidence: 99%