Coronary Heart Disease in Chronic Schizophrenic Patients

Abstract

An investigation of 1,275 autopsy protocols and available clinical records of white, male, chronic schizophrenic patients, 40 years or older, with an average length of hospitalization of over 20 years, showed that (a) the prevalence of coronary heart disease as a cause of death was as high in this group of schizophrenic subjects (31 per cent) as in the comparable section of the general population; (b) the fatality rate (66 per cent) of coronary heart disease, (c) the incidence of sudden death (64 per cent of all deaths from coronary heart disease), (d) the incidence of myocardial rupture (21.7 per cent of all fresh myocardial infarctions) and (e) the incidence of painless heart attacks were higher in schizophrenic patients (60 per cent) than in the general population; (f) myocardial aneurysm was found less commonly in schizophrenic patients (2 per cent of all patients who either died of coronary heart disease or other causes but showed old infarct or old occlusion), and (g) there was an almost complete absence of anginal syndrome preceding or following myocardial infarction.

Are Patients With Schizophrenia Insensitive to Pain? A Reconsideration of the Question

“…[38][39][40] Taken together, these clinical results are not consistent and need to be clarified by additional experimental studies. [41][42][43][44][45][46][47] Experimental studies on pain perception in schizophrenia are mainly based on a psychophysical method (selfmeasurement of pain perception using a scale) or a method using the signal detection theory (the pain response is measured by the individual's ability to discriminate the sensory stimuli and by response criteria reflecting their attitude after painful stimuli). Most of the experimental studies that have examined the responses of individuals with schizophrenia to thermal, electrical, pinprick, cold pressor, and pressure pain have reported abnormal pain perception in terms of pain threshold, pain tolerance, sensation detection threshold, and sensory discrimination (Table 3).…”

The Relationship of Myocardial Infarction to Depressive Illness

“…H ussar, in a clinicopathologic study of coronary heart disease in chronic schizophrenic patients, has shown that autopsy protocols of pa tients hospitalized in a psychiatric institution showed a 31 % prevalence rate of coronary artery disease as diagnosed post mortem [10], It is diffi cult to compare H ussar's and our observations since his are based mainly on autopsies and totally exclude other psychiatric illnesses such as the depressions which we, led by the impression guiding us, have brought into focus.…”

Schizophrénies et réactivité à la douleur

“…Les résultats de ces études de cas unique, dont on pourrait critiquer la portée du fait de la difficulté à les généraliser, ont été confirmés par des recherches réalisées sur des groupes de patients. Dès les années 60, des études ont été menées sur ce sujet [24,[26][27][28][29]. Marchand et al, en 1959, rapportaient que la douleur comme plainte fonctionnelle initiale chez des personnes ayant un ulcère gastrique perforé était présente chez 95 % d'entres elles, mais seulement chez 37 % des patients atteints de schizophrénie.…”

“…Dans le même travail, la douleur habituellement associée à l'appendicite aiguë n'était observée que dans 21 % des cas chez les patients schizophrènes [29]. L'infarctus du myocarde, pathologie pour laquelle une douleur est présente dans 90 % des cas, a fait l'objet de travaux documentés sur des cohortes de 10 à 30 patients schizophrènes [24,26,27]. Dans une étude de Marchand et al, 18 % des patients schizophrènes exprimaient une douleur avec un infarctus du myocarde [29].…”