Mortality in Schizophrenia: Clinical and Serological Predictors

Abstract

Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes. Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication. The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation. We prospectively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample from which antibodies to human herpes viruses and Toxoplasma gondii were measured. Mortality was determined with data from the National Death Index following a period of up to 11 years. We examined the role of demographic, serological, and clinical factors on mortality. A total of 25 (5%) of 517 persons died of natural causes. The standardized mortality ratio was 2.80 (95% CI 0.89, 6.38). After adjusting for age and gender, mortality from natural causes was predicted in separate models by cigarette smoking (relative risk [RR] = 4.66, P = .0029); lower cognitive score (RR = 0.96, P = .013); level of antibodies to Epstein-Barr virus (RR = 1.22, P = .0041) and to Herpes Simplex virus type 1 (RR = 1.19, P = .030); immunologic disease (RR = 3.14, P = .044); and genitourinary disease (RR = 2.70; P = .035). Because cigarette smoking confers an almost 5-fold risk of mortality, smoking cessation is an urgent priority. Having an elevated level of antibodies to Epstein-Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes.

Leukocyte telomere length: Effects of schizophrenia, age, and gender

“…Schizophrenia is associated with major medical co-morbidity, a 3-to 5-fold increase in premature death, and an estimated 15e20 years of shortened life span (Dickerson et al, 2014;Kilbourne et al, 2009;Kirkpatrick et al, 2008;Olfson et al, 2015). This has led to a suggestion that schizophrenia is associated with accelerated biological aging (Anthes, 2014;Dawes et al, 2011;Kirkpatrick et al, 2008;Kochunov et al, 2013;Koutsouleris et al, 2014;Lindqvist et al, 2015;Okusaga, 2014;Schnack et al, 2016;Shivakumar et al, 2014).…”

Mortality in Schizophrenia and Other Psychoses: Data from the South Korea National Health Insurance Cohort, 2002–2013

“…Several previous studies have explored the elevated mortality risks commonly found in mental disorder patients and have conveyed that individuals diagnosed with substance use disorder, schizophrenia, and bipolar disorder show higher risks for all-cause mortality (2). In fact, life expectancies of schizophrenia patients have been known to be 10 to 25 years shorter than that of the general population (3). Similarly, bipolar disorder has been associated with decreased life expectancy by around nine to 14 years and behavioral disorder resulting from alcohol and substance use has been related with an increased risk of death (45).…”

The use of peer mentors to enhance a smoking cessation intervention for persons with serious mental illnesses.

“…Recent data from psychiatric settings in central Maryland indicate that more than 60% of persons with schizophrenia and more than 40% of persons with bipolar disorder are cigarette smokers compared with fewer than 20% of persons in the general population (Dickerson, Stallings, Origoni, Vaughan, et al, 2013). Smoking represents an urgent problem in persons with serious mental illness because tobacco use is a primary cause of the excess premature mortality in this group (Dickerson, Stallings, Origoni, Schroeder, et al, 2013; Laursen, Munk-Olsen, & Vestergaard, 2012; Ringen, Engh, Birkenaes, Dieset, & Andreassen, 2014). Interventions using a combination of pharmacologic and counseling strategies have been developed to treat smoking in persons with serious mental illness; however, quit rates even among the best cessation programs and therapies are modest (Bennett, Wilson, Genderson, & Saperstein, 2013; Evins et al, 2014; Tsoi, Porwal, & Webster, 2013; Weiner et al, 2012).…”