Mortality in schizophrenia and related psychoses: data from two cohorts, 1875–1924 and 1994–2010

Abstract

ObjectiveTo investigate death rates in schizophrenia and related psychoses.DesignData from two epidemiologically complete cohorts of patients presenting for the first time to mental health services in North Wales for whom there are at least 1, and up to 10-year follow-up data have been used to calculate survival rates and standardised death rates for schizophrenia and related psychoses.SettingThe North Wales Asylum Denbigh (archived patient case notes) and the North West Wales District General Hospital psychiatric unit.PopulationCohort 1: The North Wales Asylum Denbigh (archived patient case notes). Of 3168 patients admitted to the North Wales Asylum Denbigh 1875–1924, 1074 had a schizophrenic or related psychosis. Cohort 2: Patients admitted between 1994 and 2010 to the North West Wales District General Hospital psychiatric unit, of whom 355 had first admissions for schizophrenia or related psychoses.ResultsWe found a 10-year survival probability of 75% in the historical cohort and a 90% survival probability in the contemporary cohort with a fourfold increase in standardised death rates in schizophrenia and related psychoses in both historical and contemporary periods. Suicide is the commonest cause of death in schizophrenia in the contemporary period (SMR 35), while tuberculosis was the commonest cause historically (SMR 9). In the contemporary data, deaths from cardiovascular causes arise in the elderly and deaths from suicide in the young.ConclusionsContemporary death rates in schizophrenia and related psychoses are high but there are particular hazards and windows of risk that enable interventions. The data point to possible interventions in the incident year of treatment that could give patients with schizophrenia a normal life expectancy.

Atypical antipsychotics and effects on feeding: from mice to men

“…Cardiovascular disease in patients with serious mental illness (SMI), second only to suicide as the greatest contributor to years of life lost (Healy et al 2012), results in premature mortality of 20-25 years (Hennekens et al 2005;Weiner et al 2011) and is likely due to a complex interaction between lifestyle (e.g., inactivity, high smoking rates) and AAP-induced metabolic side effects. In addition, AAP-induced weight gain and associated medical comorbidity have been found to adversely affect medication compliance, self-esteem, quality of life, and functional outcomes (De Hert et al 2006a;De Hert et al 2006b;Kurzthaler and Fleischhacker 2001;Lyketsos et al 2002).…”

Niveau de vigilance des psychiatres pour les facteurs de risque cardiovasculaire chez les patients schizophrènes

“…Les patients souffrant de schizophrénie ont un taux de mortalité 3 à 4 fois supérieur et une espérance de vie diminuée par rapport à la population générale [1][2][3][4][5][6][7]. Cet excès de mortalité est lié en partie aux suicides et décès d'origine accidentelle [2,8], mais s'explique également par la fréquence élevée des co-morbidités cardiovasculaires et métaboliques [1,3,5,[9][10][11].…”

Do adverse perinatal events predict mortality in schizophrenia during midlife?

“…The strengths of the study were that NFBC 1966 was a population-based cohort study and we were able to focus also on individuals with NSSD, who are studied less often (Castagnini et al 2013;Healy et al 2012). Prospective collection of data was unique (Rantakallio 1969) applying to study perinatal circumstances as predictors of mortality in a long 45-year follow-up.…”

“…Individuals with schizophrenia may die younger than those with other psychotic disorders (Healy et al 2012), but natural-cause mortality did not differ between schizophrenia and acute and transient psychotic disorders (ATPD) (Castagnini et al 2013). However, individuals with ATPD were more likely to commit suicide during the first year following the initial episode than individuals with schizophrenia (Castagnini et al 2013).…”

“…Few studies have examined differences in mortality in schizophrenia and non-schizophrenic psychoses (Castagnini et al 2013;Healy et al 2012). Individuals with schizophrenia may die younger than those with other psychotic disorders (Healy et al 2012), but natural-cause mortality did not differ between schizophrenia and acute and transient psychotic disorders (ATPD) (Castagnini et al 2013).…”