Total mortality in people admitted to a psychiatric hospital

Hansen, Vidje; Arnesen, Egil; Jacobsen, Bjarne K.

doi:10.1192/bjp.170.2.186

Cited by 45 publications

(32 citation statements)

References 18 publications

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“…Our finding of excess mortality across all age groups of psychiatric patients has been well described [34–37]. However, the decline in the aRR of all-cause and cardiac mortality with increasing age is surprising.…”

Section: Discussionsupporting

confidence: 71%

Risk of Mortality (Including Sudden Cardiac Death) and Major Cardiovascular Events in Atypical and Typical Antipsychotic Users: A Study with the General Practice Research Database

Murray‐Thomas

Jones

Patel

et al. 2013

Cardiovascular Psychiatry and Neurology

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Objective. Antipsychotics have been associated with increased cardiac events including mortality. This study assessed cardiac events including mortality among antipsychotic users relative to nonusers. Methods. The General Practice Research Database (GPRD) was used to identify antipsychotic users, matched general population controls, and psychiatric diseased nonusers. Outcomes included cardiac mortality, sudden cardiac death (SCD), all-cause mortality (excluding suicide), coronary heart disease (CHD), and ventricular arrhythmias (VA). Sensitivity analyses were conducted for age, dose, duration, antipsychotic type, and psychiatric disease. Results. 183,392 antipsychotic users (115,491 typical and 67,901 atypical), 544,726 general population controls, and 193,920 psychiatric nonusers were identified. Nonusers with schizophrenia, dementia, or bipolar disorder had increased risks of all-cause mortality compared to general population controls, while nonusers with major depression had comparable risks. Relative to psychiatric nonusers, the adjusted relative ratios (aRR) of all-cause mortality in antipsychotic users was 1.75 (95% CI: 1.64–1.87); cardiac mortality 1.72 (95% CI: 1.42–2.07); SCD primary definition 5.76 (95% CI: 2.90–11.45); SCD secondary definition 2.15 (95% CI: 1.64–2.81); CHD 1.16 (95% CI: 0.94–1.44); and VA 1.16 (95% CI: 1.02–1.31). aRRs of the various outcomes were lower for atypical versus typical antipsychotics (all-cause mortality 0.83 (95% CI: 0.80–0.85); cardiac mortality 0.89 (95% CI: 0.82–0.97); and SCD secondary definition 0.76 (95% CI: 0.55–1.04). Conclusions. Antipsychotic users had an increased risk of cardiac mortality, all-cause mortality, and SCD compared to a psychiatric nonuser cohort.

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Section: Discussionsupporting

confidence: 71%

Risk of Mortality (Including Sudden Cardiac Death) and Major Cardiovascular Events in Atypical and Typical Antipsychotic Users: A Study with the General Practice Research Database

Murray‐Thomas

Jones

Patel

et al. 2013

Cardiovascular Psychiatry and Neurology

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“…Psychiatric patients have elevated mortality rates, between 36-100% higher than those of the general population (Rorsman, 1974;Murphy et al, 1989). Despite progress in psycho-pharmacologic and psychotherapeutic treatment options, people with psychiatric illness continue to have increased mortality (Hansen et al, 1997). Elevated mortality rates also include subjects with mood disorder (Murphy et al, 1987;Ösby et al, 2001;Angst et al, 2002;Angst et al, 2012); these findings have been demonstrated in both clinical samples of hospitalised subjects and epidemiological studies of general populations (Zheng et al, 1997, Murphy et al, 1987.…”

Section: Introductionmentioning

confidence: 87%

“…Similarly, a Norwegian study showed minimal improvement in the mortality rate in males 4 over the previous 50 years in spite of better treatment options (Hansen et al, 1997). The Stirling County Study reported that depressed men had a significant risk of mortality not detected among matched depressed women (Murphy et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Mortality of subjects with mood disorders in the Lundby community cohort: A follow-up over 50 years

Mattisson

Bogren

Brådvik

et al. 2015

Journal of Affective Disorders

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Mortality of subjects with mood disorders in the LundbyLink to publication Citation for published version (APA): Mattisson, C., Bogren, M., Brådvik, L., & Horstmann, V. (2015). Mortality of subjects with mood disorders in the Lundby community cohort: A follow-up over 50 years. Journal of Affective Disorders, 178, 98-106. DOI: 10.1016/j.jad.2015 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background: The Lundby study is a longitudinal study that investigated mental health in an unselected population. The study commenced in 1947; the population was further investigated in 1957, 1972, and 1997.Methods: Experienced psychiatrists performed semi-structured diagnostic interviews, and best estimate consensus diagnoses of mental disorders were assessed at each field investigation.Subjects with mood disorder (n= 508, 195 males, 313 females) were identified until 1997.Causes and dates of death between 1947 and 2011 were obtained from the Swedish cause of death register and were compared between subjects diagnosed with mood disorder and other participants.Mortality was compared between those with mood disorders and the remaining cohort with Cox regression analyses. Other mental disorders were considered as risk factors for death for subjects with mood disorders. Results:The hazard ratio for mortality in mood disorders was HR=1.18. However, the mortality was elevated only for males, HR=1.5. A total of 6.3% of the participants with mood disorder and 1.2% of the remaining participants committed suicide. Comorbid anxiety disorders, organic disorders, dementia and psychotic disorders were significant risk factors for death.Conclusions: As expected, the suicide rate was higher among participants with mood disorders. Only males with mood disorders had elevated mortality. The impact on mortality from other mental disorders seems to vary between the genders.3

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“…Mortality is higher in male than in female patients, especially when they are young (Hansen et al, 1997). This excess in mortality is partly linked to the use of psychotropic drugs, especially anti-depressants and neuroleptics (Frassati et al, 2004; Raviña et al, 2007b; Alvarez and Pahissa, 2010), but also amphetamines (Yim et al, 2008) and amphetamine-like derivatives, such as methylphenidate (Langendijk and Wilde, 2006) or lithium salts (Yap et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Sudden Death of Cardiac Origin and Psychotropic Drugs

Timour¹,

Frassati²,

Descotes³

et al. 2012

Front. Pharmacol.

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Mortality rate is high in psychiatric patients versus general population. An important cause of this increased mortality is sudden cardiac death (SCD) as a major side-effect of psychotropic drugs. These SCDs generally result from arrhythmias occurring when the posology is high and may attain a toxic threshold but also at dosages within therapeutic range, in the presence of risk factors. There are three kinds of risk factors: physiological (e.g., low cardiac rate of sportsmen), physiopathological (e.g., hepatic insufficiency, hypothyroidism) and “therapeutic” (due to interactions between psychotropic drugs and other medicines). Association of pharmacological agents may increase the likelihood of SCDs either by (i) a pharmacokinetic mechanism (e.g., increased torsadogenic potential of a psychotropic drug when its destruction and/or elimination are compromised) or (ii) a pharmacodynamical mechanism (e.g., mutual potentiation of proarrhythmic properties of two drugs). In addition, some psychotropic drugs may induce sudden death in cases of pre-existing congenital cardiopathies such as (i) congenital long QT syndrome, predisposing to torsade de pointes that eventually cause syncope and sudden death. (ii) A Brugada syndrome, that may directly cause ventricular fibrillation due to reduced sodium current through Nav1.5 channels. Moreover, psychotropic drugs may be a direct cause of cardiac lesions also leading to SCD. This is the case, for example, of phenothiazines responsible for ischemic coronaropathies and of clozapine that is involved in the occurrence of myocarditis. The aims of this work are to delineate: (i) the risk of SCD related to the use of psychotropic drugs; (ii) mechanisms involved in the occurrence of such SCD; (iii) preventive actions of psychotropic drugs side effects, on the basis of the knowledge of patient-specific risk factors, documented from clinical history, ionic balance, and ECG investigation by the psychiatrist.

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Total mortality in people admitted to a psychiatric hospital

Abstract: The mortality of psychiatric patients is still unsatisfactorily high, and men constitute a special high-risk group.

Cited by 45 publications

References 18 publications

Risk of Mortality (Including Sudden Cardiac Death) and Major Cardiovascular Events in Atypical and Typical Antipsychotic Users: A Study with the General Practice Research Database

Risk of Mortality (Including Sudden Cardiac Death) and Major Cardiovascular Events in Atypical and Typical Antipsychotic Users: A Study with the General Practice Research Database

Mortality of subjects with mood disorders in the Lundby community cohort: A follow-up over 50 years

Sudden Death of Cardiac Origin and Psychotropic Drugs

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