Frailty and Treatment-Resistant Schizophrenia: A Retrospective Cohort Study

Pearson, Ella; Siskind, Dan; Hubbard, Ruth E.; Gordon, Emily H; Coulson, Elizabeth J.; Arnautovska, Urška; Warren, Nicola

doi:10.1007/s10597-022-00998-8

Cited by 12 publications

(13 citation statements)

References 35 publications

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“…This study demonstrates a 3–18 times increase in frailty among people with SMI compared with controls in over 500 000 UK Biobank participants. This is the largest study of frailty in people with SMI and these findings corroborate and enhance those of smaller studies 15 – 17 , 32 and of studies of people with common mental illness 10 as well as reflecting the known increase of physical health comorbidity in SMI. 5 Similar to those without SMI, the prevalence of frailty was greater in women and increased with age.…”

Section: Discussionsupporting

confidence: 84%

“… 40 This may indicate that potentially an even greater frailty could be expected in those with more severe disorders. 32 However, it should be appreciated that the direction and magnitude of selection bias cannot be determined from this study. Around 12% of the SMI group had more than one SMI diagnosis, and there may have been some misclassification between bipolar affective disorder or schizoaffective disorder and severe depression.…”

Section: Discussionmentioning

confidence: 88%

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Prevalence of frailty in severe mental illness: findings from the UK Biobank

Warren,

Leske,

Arnautovska

et al. 2023

BJPsych open

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Background Severe mental illness (SMI) is associated with significant morbidity. Frailty combines biological ageing, comorbidity and psychosocial factors and can predict adverse health outcomes. Emerging evidence indicates that frailty is higher in individuals with SMI than in the general population, although studies have been limited by sample size. Aims To describe the prevalence of frailty in people with SMI in a large cohort using three different frailty measures and examine the impact of demographic and sociodemographic variables. Method The UK Biobank survey data, which included individuals aged 37–73 years from England, Scotland and Wales from 2006 to 2010, with linked in-patient hospital episodes, were utilised. The prevalence of frailty in individuals with and without SMI was assessed through three frailty measures: frailty index, physical frailty phenotype (PFP) and Hospital Frailty Risk Score (HFRS). Stratified analysis and dichotomous logistic regression were conducted. Results A frailty index could be calculated for 99.5% of the 502 412 UK Biobank participants and demonstrated greater prevalence of frailty in women and an increase with age. The prevalence of frailty for those with SMI was 3.19% (95% CI 3.0–3.4), 4.2% (95% CI 3.8–4.7) and 18% (95% CI 15–23) using the frailty index, PFP and HFRS respectively. The prevalence ratio was between 3 and 18 times higher than in those without SMI. Conclusions As a measure, frailty captures the known increase in morbidity associated with SMI and may potentially allow for earlier identification of those who will benefit from targeted interventions.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 88%

Prevalence of frailty in severe mental illness: findings from the UK Biobank

Warren,

Leske,

Arnautovska

et al. 2023

BJPsych open

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“…This has led to the development of multimodal interventions effective in targeting lifestyle factors and multidisciplinary care 11–13. Despite people with severe mental illness showing higher overall prevalence rates of frailty and a higher likelihood of becoming prematurely frail than the general population, frailty has been minimally investigated in this group 8 14…”

Section: Introductionmentioning

confidence: 99%

Comprehensive Geriatric Assessment for younger outpatients with severe mental illness: protocol for a feasibility study

et al. 2023

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IntroductionIndividuals with severe mental illness are at risk of becoming prematurely frail. There is a critical unmet need for an intervention that reduces the risk of frailty and minimises the associated negative outcomes in this population. This study aims to provide novel evidence on the feasibility, acceptability and preliminary effectiveness of Comprehensive Geriatric Assessment (CGA) to improve health outcomes among people with co-occurring frailty and severe mental illness.Methods and analysisTwenty-five participants with frailty and severe mental illness, aged 18–64 years, will be recruited from Metro South Addiction and Mental Health Service outpatient clinics and provided with the CGA. Primary outcome measures will include the feasibility and acceptability of the CGA embedded in routine healthcare. Other variables of interest will include frailty status, quality of life, polypharmacy, and a range of mental and physical health factors.Ethics and disseminationAll procedures involving human subjects/patients were approved by Metro South Human Research Ethics Committee (HREC/2022/QMS/82272). Study findings will be disseminated through peer-reviewed publications and conference presentations.

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“…Nevertheless, regarding the relationship between frailty and schizophrenia, research is relatively limited and mainly focuses on the adverse effects of frailty in patients diagnosed with schizophrenia. For instance, the previous retrospective cohort study analyzed the frailty status of 78 adults with treatment-resistant schizophrenia and found that frailty was at a very high prevalence and positively correlated to disease severity 14 . In addition, another two observational studies discovered that schizophrenia and fragile individuals were more likely to reduce employment duration and income 15 , and had a lower life quality 16 .…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Frailty and Schizophrenia: A Genetic Association and Mendelian Randomization Study

Deng,

Wang,

Liu

et al. 2023

Preprint

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Importance Frailty was associated with elevated risks of various diseases and could induce many adverse outcomes in schizophrenia patients. However, the association and causality between frailty and schizophrenia are still unclear.Objective To investigate the genetic association and causality between frailty and schizophrenia.Design, Setting, and Participants We obtained the summary genetic data related to frailty and schizophrenia from the large-scale genome-wide association studies in the European population. Genetic association analyses were investigated from 5 aspects: global genetic correlation, local genetic correlation, shared genomic loci, overlapped tissue enrichments, and shared functional genes. The causality was inferred via the bidirectional Mendelian Randomization (MR) analyses.Main Outcomes and Measures The genetic association and causality between frailty and schizophrenia.Results The global genetic correlation analyses presented they were positively associated, and the local genetic correlation analyses demonstrated they were locally correlated in three genomes. Furthermore, 111 genomic loci were found to be jointly associated with frailty and schizophrenia. Additionally, the tissue enrichment and summary-data-based MR analyses demonstrated the genetic variants related to frailty and schizophrenia have overlapped tissue enrichments and functional genes in the brain. Lastly, the MR results implied there was a bidirectional causal relationship between frailty and schizophrenia.Conclusions and Relevance Our study indicated that frailty and schizophrenia had plenty of shared genetic basis and supported their bidirectional causality. Further studies are warranted to validate these findings in non-European populations.

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Frailty and Treatment-Resistant Schizophrenia: A Retrospective Cohort Study

Cited by 12 publications

References 35 publications

Prevalence of frailty in severe mental illness: findings from the UK Biobank

Prevalence of frailty in severe mental illness: findings from the UK Biobank

Comprehensive Geriatric Assessment for younger outpatients with severe mental illness: protocol for a feasibility study

The Relationship Between Frailty and Schizophrenia: A Genetic Association and Mendelian Randomization Study

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