Postoperative confusion in schizophrenic patients is affected by interleukin-6

Kudoh, Akira; Takase, Hajime; Takahira, Yoko; Katagai, Hiroshi; Takazawa, Tomoko

doi:10.1016/j.jclinane.2003.03.008

Cited by 24 publications

(19 citation statements)

References 20 publications

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“…This disparity should be of concern. Moreover, mentally ill patients are more likely to undergo postoperative complications, such as deep vein thrombosis, sepsis and respiratory failure [24]. These complications may delay the beginning of adjuvant radiotherapy or chemotherapy and cause poor prognosis for survival rates [25].…”

Section: Discussionmentioning

confidence: 99%

Disparities in Oral Cancer Survival among Mentally Ill Patients

Chang

Hou

et al. 2013

PLoS ONE

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BackgroundMany studies have reported excess cancer mortality in patients with mental illness. However, scant studies evaluated the differences in cancer treatment and its impact on survival rates among mentally ill patients. Oral cancer is one of the ten most common cancers in the world. We investigated differences in treatment type and survival rates between oral cancer patients with mental illness and without mental illness.MethodsUsing the National Health Insurance (NHI) database, we compared the type of treatment and survival rates in 16687 oral cancer patients from 2002 to 2006. The utilization rate of surgery for oral cancer was compared between patients with mental illness and without mental illness using logistic regression. The Cox proportional hazards model was used for survival analysis.ResultsOral cancer patients with mental disorder conferred a grave prognosis, compared with patients without mental illness (hazard ratios [HR] = 1.58; 95% confidence interval [CI] = 1.30–1.93; P<0.001). After adjusting for patients’ characteristics and hospital characteristics, patients with mental illness were less likely to receive surgery with or without adjuvant therapy (odds ratio [OR] = 0.47; 95% CI = 0.34–0.65; P<0.001). In multivariate analysis, oral cancer patients with mental illness carried a 1.58-times risk of death (95% CI = 1.30–1.93; P<0.001).ConclusionsOral cancer patients with mental illness were less likely to undergo surgery with or without adjuvant therapy than those without mental illness. Patients with mental illness have a poor prognosis compared to those without mental illness. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this vulnerable group.

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Section: Discussionmentioning

confidence: 99%

Disparities in Oral Cancer Survival among Mentally Ill Patients

Chang

Hou

et al. 2013

PLoS ONE

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“…In particular, elevated plasma levels of IL-6 have been consistently reported in patients and first-degree relatives with mood disorders (Ganguli et al, 1994;Naudin et al, 1996;Nunes et al, 2005), and correlate with exacerbation of psychotic episodes (Ganguli et al, 1994;Naudin et al, 1996;Lin et al, 1998;Zhang et al, 2002;Kudoh et al, 2003;Nunes et al, 2005). Furthermore, treatment with atypical antipsychotics can alter circulating cytokines (Pollmacher et al, 2000).…”

Section: Mechanism Of Activation Of Nox2 In Neuronsmentioning

confidence: 99%

Does schizophrenia arise from oxidative dysregulation of parvalbumin-interneurons in the developing cortex?

2009

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An imbalance in the redox-state of the brain may be part of the underlying pathophysiology in schizophrenia. Inflammatory mediators, such as IL-6, which can tip the redox balance into a prooxidant state, have been consistently found to be altered in schizophrenia patients. However, the relationship of altered redox-state to altered brain functions observed in the disease has been unclear. Recent data from a pharmacological model of schizophrenia suggest that redox and inflammatory imbalances may be directly linked to the pathophysiology of the disease by alterations in fast-spiking interneurons. Repetitive adult-exposure to the NMDA-R antagonist ketamine increases the levels of the proinflammatory cytokine interleukin-6 in brain which, through activation of the superoxide-producing enzyme NADPH-oxidase (Nox2), leads to the loss of the GABAergic phenotype of PV-interneurons and to decreased inhibitory activity in prefrontal cortex. This effect is not observed after a single exposure to ketamine, suggesting that the first exposure to the NMDA-R antagonist primes the brain such that deleterious effects on PVinterneurons appear upon repetitive exposures. The effects of activation of the IL-6/Nox2 pathway on the PV-interneuronal system are reversible in the adult brain, but permanent in the developing cortex. The slow development of PV-interneurons, while essential for shaping of neuronal circuits during postnatal brain development, increases their vulnerability to deleterious insults that can permanently affect their maturational process. Thus, in individuals with genetic predisposition, the persistent activation of the IL-6/Nox2 pathway may be an environmental factor that tips the redoxbalance leading to schizophrenia symptoms in late adolescence and early adulthood.

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“…Three reports suggested that patients with schizophrenia have more postoperative complications including death and may present at later stage of surgical disease [6–8]. Two found that pre-operative discontinuation of psychotropic medication in patients with schizophrenia or depression resulted in more postoperative delirium, confusion, and psychiatric symptoms than when medications were continued [9, 10]. The systematic review found no studies of clinical outcomes of surgery for patients with preoperative PTSD or bipolar disorder.…”

Section: Introductionmentioning

confidence: 99%

Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration

et al. 2015

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BackgroundThe STOPP study (Surgical Treatment Outcomes for Patients with Psychiatric Disorders) analyzed variation in rates and types of major surgery by serious mental illness status among patients treated in the Veterans Health Administration (VA). VA patients are veterans of United States military service who qualify for federal care by reason of disability, special service experiences, or poverty.MethodsSTOPP conducted a secondary data analysis of medical record extracts for seven million VA patients treated Oct 2005-Sep 2009. The retrospective study aggregated inpatient surgery events, comorbid diagnoses, demographics, and postoperative 30-day mortality.ResultsSerious mental illness -- schizophrenia, bipolar disorder, posttraumatic stress disorder, or major depressive disorder, was identified in 12 % of VA patients. Over the 4-year study period, 321,131 patients (4.5 %) underwent surgery with same-day preoperative or immediate post-operative admission including14 % with serious mental illness. Surgery patients were older (64 vs. 61 years) and more commonly African-American, unmarried, impoverished, highly disabled (24 % vs 12 % were Priority 1), obese, with psychotic disorder (4.3 % vs 2.9 %). Among surgery patients, 3.7 % died within 30 days postop. After covariate adjustment, patients with pre-existing serious mental illness were relatively less likely to receive surgery (adjusted odds ratios 0.4-0.7).ConclusionsVA patients undergoing major surgery appeared, in models controlling for comorbidity and demographics, to disproportionately exclude those with serious mental illness. While VA preferentially treats the most economically and medically disadvantaged veterans, the surgery subpopulation may be especially ill, potentially warranting increased postoperative surveillance.

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Postoperative confusion in schizophrenic patients is affected by interleukin-6

Cited by 24 publications

References 20 publications

Disparities in Oral Cancer Survival among Mentally Ill Patients

Disparities in Oral Cancer Survival among Mentally Ill Patients

Does schizophrenia arise from oxidative dysregulation of parvalbumin-interneurons in the developing cortex?

Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration

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