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Jaén-Moreno MJ, Rico-Villademoros F, Ruiz-Rull C, Laguna-Muñoz D, Del Pozo GI, Sarramea F. A Systematic Review on the Association between Schizophrenia and Bipolar Disorder with Chronic Obstructive Pulmonary Disease. COPD 2023; 20:31-43. [PMID: 36655855 DOI: 10.1080/15412555.2022.2154646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A systematic review aimed to investigate the association between schizophrenia and bipolar disorder and chronic obstructive pulmonary disease (COPD), its prevalence and incidence, potential factors associated with its occurrence and its impact on mortality among these patients. We performed the literature search in PubMed, Scopus and PsycInfo from inception to February 2022 and identified 19 studies: ten cross-sectional, 5 that included cross-sectional and longitudinal analyses, and 4 retrospective cohort studies. The reported prevalence of COPD ranged from 2.6% to 52.7% in patients with schizophrenia and between 3.0% and 12.9% in patients with bipolar disorder. Two studies reported an annual incidence of COPD of 2.21 cases/100 person-years in patients with schizophrenia and 2.03 cases/100 person-years in patients with bipolar disorder. Among the risk factors evaluated in three studies, only advanced age was consistently associated with the presence/occurrence of COPD in patients with schizophrenia and bipolar disorder; the role of tobacco consumption was not investigated in those three studies. According to two studies, the likelihood of mortality from COPD showed an over 3-fold increase in patients with schizophrenia and a 2-fold increase in those with bipolar disorder compared to the overall population; COPD was also associated with increased inpatient mortality. Available data indicate that COPD in patients with schizophrenia and bipolar disorder is a major public health problem. National and international health organizations should strive to specifically address this issue by creating awareness about this health problem and developing specific programs for screening and early intervention aimed to reduce the burden of COPD in these populations.
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Affiliation(s)
- María José Jaén-Moreno
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
| | | | - Cristina Ruiz-Rull
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Medicina Familiar y Comunitaria, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - David Laguna-Muñoz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Gloria Isabel Del Pozo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fernando Sarramea
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Oviedo, Spain
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Kennedy E, Panahi S, Stewart IJ, Tate DF, Wilde EA, Kenney K, Werner JK, Gill J, Diaz-Arrastia R, Amuan M, Van Cott AC, Pugh MJ. Traumatic Brain Injury and Early Onset Dementia in Post 9-11 Veterans. Brain Inj 2022; 36:620-627. [DOI: 10.1080/02699052.2022.2033846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Eamonn Kennedy
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Samin Panahi
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ian J. Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David F. Tate
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elisabeth A. Wilde
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - J. Kent Werner
- Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jessica Gill
- John Hopkins, School of Nursing and Medicine, Baltimore, Maryland, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Megan Amuan
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
| | - Anne C. Van Cott
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Health Care System, Pittsburgh Pennsylvania, USA
| | - Mary Jo Pugh
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Suetani S, Honarparvar F, Siskind D, Hindley G, Veronese N, Vancampfort D, Allen L, Solmi M, Lally J, Gaughran F, Stubbs B, Pillinger T. Increased rates of respiratory disease in schizophrenia: A systematic review and meta-analysis including 619,214 individuals with schizophrenia and 52,159,551 controls. Schizophr Res 2021; 237:131-140. [PMID: 34521040 DOI: 10.1016/j.schres.2021.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Despite respiratory disease being a major cause of excess mortality in people with schizophrenia, the prevalence of respiratory conditions in this population is poorly defined. A systematic review and meta-analysis were conducted to establish the prevalence and association of respiratory diseases in people with schizophrenia. MATERIAL AND METHODS Major electronic databases were searched from inception to 27 April 2020 for articles reporting respiratory disease (asthma, chronic obstructive pulmonary disease [COPD], pneumonia, and tuberculosis) in people with schizophrenia and, where possible, a control group. A random-effects meta-analysis was conducted. The study was registered with PROSPERO (CRD42018115137). RESULTS Of 1569 citations, 21 studies consisting of 619,214 individuals with schizophrenia and 52,159,551 controls were included in the meta-analysis. Compared to the general population, people with schizophrenia had significantly higher rates of COPD (odds ratio [OR]: 1.82, 95% CI: 1.28-2.57), asthma (OR: 1.70, 95% CI: 1.02-2.83), and pneumonia (OR: 2.62, 95% CI: 1.10-6.23). In people with schizophrenia, the prevalence of COPD was 7.7% (95% CI: 4.0-14.4), asthma 7.5% (95% CI: 4.9-11.3), pneumonia 10.3% (95% CI 5.4-18.6), and tuberculosis 0.3% (95% CI 0.1 -0.8). After adjusting for publication bias, the prevalence of COPD increased to 19.9% (95% CI: 9.6-36.7). DISCUSSION All respiratory diseases examined were significantly more prevalent in people with schizophrenia compared with the general population. Future studies should focus on improving the prevention and management of respiratory disease in this group to reduce associated excess mortality.
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Affiliation(s)
- Shuichi Suetani
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD 4076, Australia; Queensland Brain Institute, The University of Queensland, St Lucia, QLD 4072, Australia; Metro South Addiction and Mental Health Services, Woolloongabba, QLD 4102, Australia; School of Medicine, Griffith University, Nathan, QLD 4111, Australia; Institute for Urban Indigenous Health, Windsor, QLD 4030, Australia
| | - Faraz Honarparvar
- School of Medicine, The University of Queensland, Herston, QLD 4102, Australia
| | - Dan Siskind
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD 4076, Australia; Metro South Addiction and Mental Health Services, Woolloongabba, QLD 4102, Australia; School of Medicine, The University of Queensland, Herston, QLD 4102, Australia
| | - Guy Hindley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90100 Palermo, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Lauren Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Marco Solmi
- Department of Neuroscience, University of Padova, Padova, Italy; Padua Neuroscience Center, University of Padova, Padova, Italy
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Brendon Stubbs
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
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Huang KH, Kuo WY, Kuan YH, Chang YC, Tsai TH, Lee CY. Risk of Pneumonia is associated with Antipsychotic Drug Use among older patients with Parkinson's Disease: A Case-control Study. Int J Med Sci 2021; 18:3565-3573. [PMID: 34522183 PMCID: PMC8436093 DOI: 10.7150/ijms.63246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/09/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the risk of pneumonia associated with the use of antipsychotic drugs in older-adult patients with Parkinson's disease (PD) in Taiwan. Methods: This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 51,158 older patients with PD for the period between 2001 and 2016. To reduce the potential confounding caused by unbalanced covariates in nonexperimental settings, we used propensity score matching to include older patients without pneumonia to serve as the control group. Results: Compared with patients who had never taken antipsychotics, current (adjusted odds ratios [aOR] =1.63, 95% confidence interval [CI] = 1.51-1.75), recent (aOR = 1.63, 95% CI = 1.52-1.74), and past (aOR = 1.89, 95% CI = 1.80-2.00) users of antipsychotics had a higher risk of incident pneumonia. Among typical and atypical antipsychotics, haloperidol and clozapine were associated with higher risks of incident pneumonia, respectively. By contrast, aripiprazole was not associated with a higher risk of pneumonia. Conclusion: Older patients with PD receiving typical antipsychotics or atypical antipsychotics had a higher risk of pneumonia. Among these antipsychotics, clozapine had the highest risk of pneumonia. Clinicians should pay attention to the risk of pneumonia in older patients with PD who receive typical antipsychotics and atypical antipsychotics.
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Affiliation(s)
- Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yu-Hsiang Kuan
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Long Term Care, National Quemoy University, Kinmen, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
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Is Antipsychotic Treatment Associated With Risk of Pneumonia in People With Serious Mental Illness?: The Roles of Severity of Psychiatric Symptoms and Global Functioning. J Clin Psychopharmacol 2020; 39:434-440. [PMID: 31425461 DOI: 10.1097/jcp.0000000000001090] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Most pneumonia-related researches in people with severe mental illness were based on insurance claims data. This study aimed for a comprehensive analysis of factors potentially associated with risk of pneumonia in psychiatric inpatients. METHODS Inpatients at a large psychiatric hospital diagnosed with pneumonia during the course of hospitalization were enrolled as cases. Controls were matched by ward and date. The diagnosis of pneumonia was confirmed by physicians based on clinical features, chest radiographs, and blood tests. A stepwise conditional logistic regression model was used to identify potential risk factors for pneumonia. RESULTS Seventy-five pneumonia cases and 436 matched controls were enrolled. Conditional logistic regression revealed 3 variables significantly associated with an increased risk of pneumonia: a higher score on the Clinical Global Impression-Severity scale (adjusted odds ratio [aOR], 3.7; 95% confidence interval [CI]. 1.5-9.1), a higher score on the Charlson comorbidity index (aOR, 2.2; 95% CI, 1.5-3.2), and a longer duration of antipsychotic treatment (aOR, 1.0; 95% CI, 1.0-1.0). Two variables were significantly associated with a decreased risk of pneumonia: a higher score on the Global Assessment of Functioning scale (aOR, 0.9; 95% CI, 0.8-0.9) and an older age of onset (aOR, 0.9; 95% CI, 0.9-1.0). After adjusting for potential confounders, use of antipsychotic or other psychotropic medications was not found to be a significant risk factor for pneumonia. CONCLUSIONS Physical comorbidities, long duration of antipsychotic treatment, early onset, severe psychiatric symptoms, and poor global functioning are associated with pneumonia in people with serious mental illness.
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Wilson R, Hepgul N, Higginson IJ, Gao W. End-of-life care and place of death in adults with serious mental illness: A systematic review and narrative synthesis. Palliat Med 2020; 34:49-68. [PMID: 31608768 DOI: 10.1177/0269216319867847] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND People with serious mental illness have greater mortality risk than the general population. They experience health care inequalities throughout life; it is not clear if this persists to end of life. AIM Assess the empirical evidence describing end-of-life care and place of death for people with serious mental illness. DESIGN A systematic review of original, peer-reviewed research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analysed using a narrative synthesis approach. DATA SOURCES Five online databases (Embase, PsycArticles, PsycINFO, Medline, PubMed) and additional sources were searched (without time restriction) for primary research reporting health care utilisation in the last year of life or place of death in adults with serious mental illness. RESULTS After full-text screening, 23 studies were included. We found studies reporting hospital admissions, emergency department care, palliative care, and general practitioner (GP) visits at end of life. We found conflicting evidence for the association between serious mental illness and end-of-life care, although different patient groups, settings and measures were used across studies. People with serious mental illness were more likely to die in care homes than the general population. There were no patterns for other places of death. CONCLUSIONS The evidence was sparse and heterogeneous, demonstrating variability in patterns and reporting of health care use and with little consensus on where people with serious mental illness are likely to die. Given that people with serious mental illness have increased mortality risk, this gap in the knowledge around end-of-life care outcomes is concerning; this area of research needs further development.
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Affiliation(s)
- Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Zareifopoulos N, Bellou A, Spiropoulou A, Spiropoulos K. Prevalence of Comorbid Chronic Obstructive Pulmonary Disease in Individuals Suffering from Schizophrenia and Bipolar Disorder: A Systematic Review. COPD 2019; 15:612-620. [PMID: 30714418 DOI: 10.1080/15412555.2019.1572730] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The disease burden associated with schizophrenia and bipolar disorder is substantial, with affected individuals having a shorter life expectancy and a high risk of severe physical comorbid conditions. These individuals are more likely to smoke and have a longer smoking history compared to the general population. Furthermore, use of antipsychotic drugs has also been linked to active smoking. Chronic obstructive pulmonary disease (COPD) is a respiratory condition affecting elderly individuals with a long smoking history, so it would be expected that individuals suffering from major mental disorders may exhibit a higher prevalence of COPD compared to the general population. We searched the databases Pubmed and Scopus for observational studies of at least 200 patients including at least one group suffering from schizophrenia or bipolar disorder and a comparison group of individuals at risk of COPD. The initial search, along with the data extraction process and the risk of bias assessment were carried out independently by the two reviewers. Eight studies were included. The risk of bias was substantial as most studies did not adequately address confounding variables. A pooled analysis showed a greater likelihood of suffering from comorbid COPD compared with the general population both for schizophrenic (OR 1.573, 1.439-1.720) and bipolar individuals (OR 1.551, 1.452-1.658). Based on these findings, COPD is more common in individuals suffering from major mental illness compared to the general population. Further research is required to ascertain whether smoking is the only cause and develop strategies for the prevention of COPD in these high-risk groups.
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Affiliation(s)
- Nicholas Zareifopoulos
- a Department of Pulmonology , School of Health Science, University of Patras , Patras , Greece
| | - Aggeliki Bellou
- a Department of Pulmonology , School of Health Science, University of Patras , Patras , Greece
| | - Agathi Spiropoulou
- a Department of Pulmonology , School of Health Science, University of Patras , Patras , Greece
| | - Kostas Spiropoulos
- a Department of Pulmonology , School of Health Science, University of Patras , Patras , Greece
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Ko YS, Tsai HC, Chi MH, Su CC, Lee IH, Chen PS, Chen KC, Yang YK. Higher mortality and years of potential life lost of suicide in patients with schizophrenia. Psychiatry Res 2018; 270:531-537. [PMID: 30342411 DOI: 10.1016/j.psychres.2018.09.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/24/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
Abstract
Patients with schizophrenia could have a higher risk of mortality. We compared the risk of mortality and the years of potential life lost (YPLL) associated with various causes of death between patients with schizophrenia and the general population. A total of 4,298 patients with schizophrenia were included. The cohort was linked to the Taiwan Death Register between 1998 and 2010 using personal identification numbers, which showed 367 patients with schizophrenia had died by the end of 2010. The standard mortality ratios (SMRs) and YPLL were analyzed by age, sex and cause of death. The overall SMR was significantly higher in patients with schizophrenia. Suicide had the most significantly greater SMR, and the SMRs for physical illnesses, accidents and injuries were all significantly greater in patients with schizophrenia. Suicide had the largest YPLL/deaths among all causes of mortality in patients with schizophrenia. Suicide had the most significantly greater risk of mortality among patients with schizophrenia as compared with the general population. Patients with schizophrenia are highly vulnerable in terms of increased mortality and require special attention.
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Affiliation(s)
- Yu Shun Ko
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Chun Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Mei Hung Chi
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chou Su
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Ponsford M, Castle D, Tahir T, Robinson R, Wade W, Steven R, Bramhall K, Moody M, Carne E, Ford C, Farewell D, Williams P, El-Shanawany T, Jolles S. Clozapine is associated with secondary antibody deficiency. Br J Psychiatry 2018; 214:1-7. [PMID: 30259827 PMCID: PMC6429246 DOI: 10.1192/bjp.2018.152] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/20/2018] [Accepted: 07/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Schizophrenia affects 1% of the population. Clozapine is the only medication licensed for treatment-resistant schizophrenia and is intensively monitored to prevent harm from neutropenia. Clozapine is also associated with increased risk of pneumonia although the mechanism is poorly understood.AimsTo investigate the potential association between clozapine and antibody deficiency. METHODS Patients taking clozapine and patients who were clozapine-naive and receiving alternative antipsychotics were recruited and completed a lifestyle, medication and infection-burden questionnaire. Serum total immunoglobulins (immunoglobulin (Ig)G, IgA, IgM) and specific IgG antibodies to haemophilus influenzae type B, tetanus and IgG, IgA and IgM to pneumococcus were measured. RESULTS Immunoglobulins were all significantly reduced in the clozapine-treated group (n = 123) compared with the clozapine-naive group (n = 111). Odds ratios (ORs) for a reduction in clozapine:control immunoglobulin values below the fifth percentile were IgG, OR = 6.00 (95% CI 1.31-27.44); IgA, OR = 16.75 (95% CI 2.18-128.60); and IgM, OR = 3.26 (95% CI 1.75-6.08). These findings remained significant despite exclusion of other potential causes of hypogammaglobulinaemia. In addition, duration on clozapine was associated with decline in IgG. A higher proportion of the clozapine-treated group reported taking more than five courses of antibiotics in the preceding year (5.3% (n = 5) versus 1% (n = 1). CONCLUSIONS Clozapine use was associated with significantly reduced immunoglobulin levels and an increased proportion of patients using more than five antibiotic courses in a year. Antibody testing is not included in existing clozapine monitoring programmes but may represent a mechanistic explanation and modifiable risk factor for the increased rates of pneumonia and sepsis-related mortality previously reported in this vulnerable cohort.Declaration of interestS.J. has received support from CSL Behring, Shire, LFB, Biotest, Binding Site, Sanofi, GSK, UCB Pharma, Grifols, BPL SOBI, Weatherden, Zarodex and Octapharma for projects, advisory boards, meetings, studies, speaker and clinical trials.
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Affiliation(s)
- Mark Ponsford
- Immunology Specialist Registrar, Immunodeficiency Centre for Wales, University Hospital of Wales and Welsh Clinical Academic Trainee, Cardiff University, UK
| | - Daniel Castle
- Neurology Specialist Registrar, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Tayyeb Tahir
- Professor of Psychiatry, Department of Liaison Psychiatry, University Hospital of Wales, UK
| | - Rebecca Robinson
- Research Officer, Health and Care Research Wales, University Hospital of Wales, UK
| | - Wendy Wade
- Research Manager, Health and Care Research Wales, University Hospital of Wales, UK
| | - Rachael Steven
- Immunology Clinical Scientist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Kathryn Bramhall
- Immunology Biomedical Scientist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Mo Moody
- Immunology Biomedical Scientist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Emily Carne
- Immunology Clinical Nurse Specialist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Catherine Ford
- Mental Health Nurse, Community Mental Health Team, University Hospital of Wales, UK
| | - Daniel Farewell
- Reader, Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, UK
| | - Paul Williams
- Consultant Immunologist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Tariq El-Shanawany
- Consultant Immunologist, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
| | - Stephen Jolles
- Professor of Clinical Immunology, Immunodeficiency Centre for Wales, University Hospital of Wales, UK
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10
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Burke AJ, Hay K, Chadwick A, Siskind D, Sheridan J. High rates of respiratory symptoms and airway disease in mental health inpatients in a tertiary centre. Intern Med J 2018; 48:433-438. [PMID: 28856801 DOI: 10.1111/imj.13594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) have a lower life expectancy due in part to a higher prevalence of cardiac and metabolic disease. Less is known of the prevalence of respiratory disease in this group. AIMS This cross-sectional, observational study aimed to assess the prevalence of symptoms associated with respiratory disease in patients admitted to an inpatient mental health unit. METHODS A convenience sample of 82 inpatients had a structured interview and questionnaire completed. The questionnaire included self-reported diagnoses of common diseases and screening questions designed to detect respiratory disease and sleep disordered breathing. Targeted spirometry was performed on the basis of symptoms and smoking status. RESULTS Patients reported high rates of respiratory symptoms, including wheezing (38%) and dyspnoea (44%); 52% of patients reported daily tobacco use. Productive cough was significantly associated with tobacco use (P < 0.005). Ten patients (18%) had spirometry consistent with chronic obstructive pulmonary disease (COPD) of whom six did not have a formal diagnosis of COPD previously. CONCLUSIONS People with SMI have high rates of respiratory symptoms with a high prevalence of COPD on spirometry. Half of the COPD cases were not previously diagnosed, suggesting a hidden burden of respiratory disease in patients with SMI.
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Affiliation(s)
- Andrew J Burke
- The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Alex Chadwick
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Dan Siskind
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Judith Sheridan
- Queensland University of Technology, Brisbane, Queensland, Australia
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11
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Shen TC, Chen CH, Huang YJ, Lin CL, Chang TC, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC. Risk of pleural empyema in patients with schizophrenia: a nationwide propensity-matched cohort study in Taiwan. BMJ Open 2018; 8:e021187. [PMID: 29982211 PMCID: PMC6042618 DOI: 10.1136/bmjopen-2017-021187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/30/2018] [Accepted: 05/14/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Thoracic infection and pneumonia are prevalent in patients with schizophrenia; however, it is unclear whether patients with schizophrenia are at an increased risk of developing pleural empyema. DESIGN A retrospective cohort study with propensity-matched cohorts with and without schizophrenia. SETTING Using the National Health Insurance Research Database of Taiwan. PARTICIPANTS We identified 55 888 patients with schizophrenia newly diagnosed in 2000-2011 and same number of individuals without schizophrenia as the comparison cohort, frequency matched by propensity scores estimated using age, sex, occupation, income, urbanisation, year of diagnosis and comorbidities. PRIMARY OUTCOME MEASURES We assessed incident pleural empyema by the end of 2011 and used the Cox proportional hazards model to calculate the schizophrenia cohort to comparison cohort HR of pleural empyema. RESULTS The overall incidence of pleural empyema was 2.44-fold greater in the schizophrenia cohort than in the comparison cohort (4.39vs1.80 per 10 000 person-years), with an adjusted HR of 2.87(95% CI 2.14 to 3.84). Stratified analyses by age, sex, occupation, income, urbanisation and comorbidity revealed significant hazards for pleural empyema associated with schizophrenia in all subgroups. CONCLUSIONS Patients with schizophrenia are at an increased risk of developing pleural empyema and require greater attention and appropriate support.
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Affiliation(s)
- Te-Chun Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Intensive Care Unit, Chu Shang Show Chwan Hospital, Nantou, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Jhen Huang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ting-Chang Chang
- Department of Business Administration, Asia University, Taichung, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chuen-Ming Shih
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
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12
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The influence of psychiatric disorders on the course of lung cancer, chronic obstructive pulmonary disease and tuberculosis. Respir Med 2018; 135:35-41. [DOI: 10.1016/j.rmed.2017.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/28/2017] [Accepted: 12/27/2017] [Indexed: 12/14/2022]
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13
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Burns A, Webb M, Stynes G, O'Brien T, Rohde D, Strawbridge J, Clancy L, Doyle F. Implementation of a Quit Smoking Programme in Community Adult Mental Health Services-A Qualitative Study. Front Psychiatry 2018; 9:670. [PMID: 30622485 PMCID: PMC6308392 DOI: 10.3389/fpsyt.2018.00670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/20/2018] [Indexed: 01/01/2023] Open
Abstract
Little is known about the experiences of people with severe mental health difficulties in smoking cessation interventions. This study aimed to review the implementation of a smoking cessation programme across 16 community mental health day services. The aim was to establish the experience from both service user and facilitator perspectives and refine implementation for future groups. In-depth interviews were conducted with 20 service users and four focus groups held with 17 facilitators. Thematic analysis was used to analyse the data for emergent themes in relation to key enablers and barriers to implementation. Data from service users and facilitators revealed that implementation was enabled by an open and engaged recruitment approach; the resourcefulness of facilitators; programme materials and group-based format; combining the cessation programme with other and broader health initiatives; and participants' motivations, including health and money. Barriers included the structure of the service; the lack of a joined-up approach across the health services; literacy issues and the serial/logical process assumed by the programme. Barriers perceived as more specific to those with mental health difficulties included the use of smoking as a coping mechanism, lack of alternative activities/structure and lack of consistent determination. The tobacco free policy, implemented shortly before the programme, interestingly emerged as both a barrier and an enabler. In conclusion, although this group-based cessation programme in community mental health settings was well-received overall, a number of key barriers persist. A joined-up approach which addresses the culture of smoking in mental health settings, inconsistencies in smoking policies, and provides consistent cessation support, is needed. Care needs to be taken with the timing as overall it may not be helpful to introduce a new smoking cessation programme at the same time as a tobacco free policy.
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Affiliation(s)
- Annette Burns
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Greg Stynes
- EVE, Health Service Executive, Dublin, Ireland
| | - Tom O'Brien
- EVE, Health Service Executive, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Luke Clancy
- TobaccoFree Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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14
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Cho J, Copeland LA, Stock EM, Zeber JE, Restrepo MI, MacCarthy AA, Ory MG, Smith PA, Stevens AB. Protective and Risk Factors for 5-Year Survival in the Oldest Veterans: Data from the Veterans Health Administration. J Am Geriatr Soc 2017; 64:1250-7. [PMID: 27321603 DOI: 10.1111/jgs.14161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To characterize physical and mental diseases and use of healthcare services and identify factors associated with mortality in the oldest individuals using the Veterans Health Administration (VHA). DESIGN Retrospective study with 5-year survival follow-up. SETTING VHA, system-wide. PARTICIPANTS Veterans using the VHA aged 80 and older as of October 2008 (N = 721,588: n = 665,249 aged 80-89, n = 56,118 aged 90-99, n = 221 aged 100-115). MEASUREMENTS Demographic characteristics, physical and mental diseases, healthcare services, and 5-year survival were measured. RESULTS Accelerated failure time models identified protective and risk factors associated with mortality according to age group. During 5 years of follow-up, 44% of participants died (survival rate: 59% aged 80-89, 32% aged 90-99, 15% aged ≥100). In the multivariable model, protective effects for veterans aged 80-99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), having urgent care visits, having invasive surgery, and having few (1-3) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (diabetes mellitus, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those aged 100 and older, being married, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective. CONCLUSION Although the data are limited to VHA care (thus missing Medicare services), this study shows that many veterans served by the VHA live to advanced old age despite multiple chronic conditions. Further study is needed to determine whether a comprehensive, coordinated care system like VHA is associated with greater longevity for very old persons.
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Affiliation(s)
- Jinmyoung Cho
- Baylor Scott & White Health, Temple, Texas.,Texas A&M Health Science Center, College Station, Texas
| | - Laurel A Copeland
- Baylor Scott & White Health, Temple, Texas.,Texas A&M Health Science Center, College Station, Texas.,Central Texas Veterans Health Care System, Temple, Texas
| | - Eileen M Stock
- Baylor Scott & White Health, Temple, Texas.,Texas A&M Health Science Center, College Station, Texas.,Central Texas Veterans Health Care System, Temple, Texas
| | - John E Zeber
- Baylor Scott & White Health, Temple, Texas.,Texas A&M Health Science Center, College Station, Texas.,Central Texas Veterans Health Care System, Temple, Texas
| | - Marcos I Restrepo
- University of Texas Health Science Center San Antonio, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | | | - Marcia G Ory
- Texas A&M Health Science Center, College Station, Texas
| | | | - Alan B Stevens
- Baylor Scott & White Health, Temple, Texas.,Texas A&M Health Science Center, College Station, Texas
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15
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Burns A, Strawbridge JD, Clancy L, Doyle F. Exploring smoking, mental health and smoking-related disease in a nationally representative sample of older adults in Ireland - A retrospective secondary analysis. J Psychosom Res 2017; 98:78-86. [PMID: 28554376 DOI: 10.1016/j.jpsychores.2017.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/05/2017] [Accepted: 05/05/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Smoking is the leading preventable cause of death among individuals with mental health difficulties (MHD). The aim of the current study was to determine the impact of smoking on the physical health of older adults with MHD in Ireland and to explore the extent to which smoking mediated or moderated associations between MHD and smoking-related diseases. METHODS Cross-sectional analysis of a nationally representative sample of 8175 community-dwelling adults aged 50 and over from The Irish Longitudinal Study on Ageing (TILDA) was undertaken. Multivariate adjusted logistic regression models were used to assess the association between MHD, smoking (current/past/never) and smoking-related diseases (respiratory disease, cardiovascular disease, smoking-related cancers). A number of variables were employed to identify individuals with MHD, including prescribed medication, self-reported diagnoses and self-report scales. RESULTS MHD was associated with current (RRRs ranging from 1.84 [1.50 to 2.26] to 4.31 [2.47 to 7.53]) and former (RRRs ranging from 1.26 [1.05 to 1.52] to 1.99 [1.19 to 3.33]) smoking and also associated with the presence of smoking-related disease (ORs ranging from 1.24 [1.01 to 1.51] to 1.62 [1.00 to 2.62]). Smoking did not mediate and rarely moderated associations between MHD and smoking-related disease. CONCLUSIONS Older adults in Ireland with MHD are more likely to smoke than those without such difficulties. They also experience higher rates of smoking-related disease, although smoking had no mediating and no consistent moderating role in these analyses. Findings underscore the need for attention to the physical health of those with MHD including support in smoking cessation.
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Affiliation(s)
- Annette Burns
- Department of Psychology, Royal College of Surgeons in Ireland, Ireland.
| | | | - Luke Clancy
- TobaccoFree Research Institute, DIT Kevin Street, Dublin 8, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Ireland
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16
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Affiliation(s)
- Mesut Cetin
- Klinik Psikofarmakoloji Bulteni-Bulletin of Clinical Pychopharmacology, Istanbul-Turkey
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17
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Malt EA, Juhasz K, Malt UF, Naumann T. A Role for the Transcription Factor Nk2 Homeobox 1 in Schizophrenia: Convergent Evidence from Animal and Human Studies. Front Behav Neurosci 2016; 10:59. [PMID: 27064909 PMCID: PMC4811959 DOI: 10.3389/fnbeh.2016.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 12/22/2022] Open
Abstract
Schizophrenia is a highly heritable disorder with diverse mental and somatic symptoms. The molecular mechanisms leading from genes to disease pathology in schizophrenia remain largely unknown. Genome-wide association studies (GWASs) have shown that common single-nucleotide polymorphisms associated with specific diseases are enriched in the recognition sequences of transcription factors that regulate physiological processes relevant to the disease. We have used a “bottom-up” approach and tracked a developmental trajectory from embryology to physiological processes and behavior and recognized that the transcription factor NK2 homeobox 1 (NKX2-1) possesses properties of particular interest for schizophrenia. NKX2-1 is selectively expressed from prenatal development to adulthood in the brain, thyroid gland, parathyroid gland, lungs, skin, and enteric ganglia, and has key functions at the interface of the brain, the endocrine-, and the immune system. In the developing brain, NKX2-1-expressing progenitor cells differentiate into distinct subclasses of forebrain GABAergic and cholinergic neurons, astrocytes, and oligodendrocytes. The transcription factor is highly expressed in mature limbic circuits related to context-dependent goal-directed patterns of behavior, social interaction and reproduction, fear responses, responses to light, and other homeostatic processes. It is essential for development and mature function of the thyroid gland and the respiratory system, and is involved in calcium metabolism and immune responses. NKX2-1 interacts with a number of genes identified as susceptibility genes for schizophrenia. We suggest that NKX2-1 may lie at the core of several dose dependent pathways that are dysregulated in schizophrenia. We correlate the symptoms seen in schizophrenia with the temporal and spatial activities of NKX2-1 in order to highlight promising future research areas.
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Affiliation(s)
- Eva A Malt
- Department of Adult Habilitation, Akershus University HospitalLørenskog, Norway; Institute of Clinical Medicine, Ahus Campus University of OsloOslo, Norway
| | - Katalin Juhasz
- Department of Adult Habilitation, Akershus University Hospital Lørenskog, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of OsloOslo, Norway; Department of Research and Education, Institution of Oslo University HospitalOslo, Norway
| | - Thomas Naumann
- Centre of Anatomy, Institute of Cell Biology and Neurobiology, Charite Universitätsmedizin Berlin Berlin, Germany
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18
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Partti K, Vasankari T, Kanervisto M, Perälä J, Saarni SI, Jousilahti P, Lönnqvist J, Suvisaari J. Lung function and respiratory diseases in people with psychosis: population-based study. Br J Psychiatry 2015; 207:37-45. [PMID: 25858177 DOI: 10.1192/bjp.bp.113.141937] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 10/17/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is little information on lung function and respiratory diseases in people with psychosis. AIMS To compare the respiratory health of people with psychosis with that of the general population. METHOD In a nationally representative sample of 8028 adult Finns, lung function was measured by spirometry. Information on respiratory diseases and symptoms was collected. Smoking was quantified with serum cotinine levels. Psychotic disorders were diagnosed utilising the Structured Clinical Interview for DSM-IV (SCID-I) and medical records. RESULTS Participants with schizophrenia and other non-affective psychoses had significantly lower lung function values compared with the general population, and the association remained significant for schizophrenia after adjustment for smoking and other potential confounders. Schizophrenia was associated with increased odds of pneumonia (odds ratio (OR) = 4.9), chronic obstructive pulmonary disease (COPD, OR = 4.2) and chronic bronchitis (OR = 3.8); and with high cotinine levels. CONCLUSIONS Schizophrenia is associated with impaired lung function and increased risk for pneumonia, COPD and chronic bronchitis.
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Affiliation(s)
- Krista Partti
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Tuula Vasankari
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Merja Kanervisto
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Jonna Perälä
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Samuli I Saarni
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Pekka Jousilahti
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Jouko Lönnqvist
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
| | - Jaana Suvisaari
- Krista Partti, MD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki, Finland; Tuula Vasankari, MD, PhD, Finnish Lung Health Association, Helsinki, Finland; Merja Kanervisto, PhD, School of Health Sciences, University of Tampere, Finland; Jonna Perälä, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, and Department of Psychiatry, Helsinki University Central Hospital, Finland; Samuli I. Saarni, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Hospital District of Southwest Finland, Turku, Finland; Pekka Jousilahti, MD, PhD, Department of Chronic Disease Prevention, Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Jouko Lönnqvist, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Finland; Jaana Suvisaari, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki and Tampere School of Public Health, University of Tampere, Finland
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19
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Copeland LA, Zeber JE, Sako EY, Mortensen EM, Pugh MJ, Wang CP, Restrepo MI, Flynn J, MacCarthy AA, Lawrence VA. Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration. BMC Surg 2015; 15:74. [PMID: 26084521 PMCID: PMC4472400 DOI: 10.1186/s12893-015-0064-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 06/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background The 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. Methods STOPP 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. Results Serious 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). Conclusions VA 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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Affiliation(s)
- Laurel A Copeland
- Veterans Affairs: Central Texas Veterans Health Care System, Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA. .,Baylor Scott & White Health: Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA. .,Texas A&M Health Science Center, College of Medicine, Bryan, TX, USA. .,UT Health Science Center San Antonio, San Antonio, TX, USA.
| | - John E Zeber
- Veterans Affairs: Central Texas Veterans Health Care System, Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA.,Baylor Scott & White Health: Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA.,Texas A&M Health Science Center, College of Medicine, Bryan, TX, USA.,UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Edward Y Sako
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Eric M Mortensen
- Veterans Affairs: North Texas Veterans Health Care System, 4500 S. Lancaster Rd, Dallas, TX, 75216, USA.,UT Southwestern Medical Center, Dallas, TX, USA
| | - Mary Jo Pugh
- UT Health Science Center San Antonio, San Antonio, TX, USA.,Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Chen-Pin Wang
- UT Health Science Center San Antonio, San Antonio, TX, USA.,Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Marcos I Restrepo
- UT Health Science Center San Antonio, San Antonio, TX, USA.,Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Julianne Flynn
- Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Andrea A MacCarthy
- Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
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Vancampfort D, Probst M, Stubbs B, Soundy A, De Herdt A, De Hert M. Metabolic syndrome and lung function in schizophrenia: a pilot study. Psychiatry Res 2014; 220:58-62. [PMID: 24999175 DOI: 10.1016/j.psychres.2014.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/17/2014] [Accepted: 06/05/2014] [Indexed: 01/09/2023]
Abstract
This pilot study aimed to explore relationships between metabolic and lung functions in patients with schizophrenia. Eighty patients with schizophrenia (55 ♂; 36.8±10.0 years) underwent a spirometry, were screened for metabolic syndrome (MetS), performed a 6-min walk test (6MWT), and completed the International Physical Activity Questionnaire and the Psychosis evaluation tool for common use by caregivers. Patients with MetS (according to the International Diabetes Federation criteria) (n=28; 35%) had a reduced predicted forced expiratory volume for 1 second (77.4±13.2% versus 87.3±12.1%) and predicted forced vital capacity (75.3±11.1% versus 85.4±11.4%). Significantly more patients with MetS were diagnosed with restrictive lung dysfunction (RLD) (according to the Global Initiative for Chronic Obstructive Lung Disease criteria) (13 versus 8). Schizophrenia patients with RLD (n=21; 26.2%) had a significantly larger waist circumference (90.7±12.5 versus 105.6±14.7 cm), were less physically active (653.6±777.9 versus 1517.9±1248.7 metabolic equivalent min/week) and walked less on the 6MWT (502.6±92.3 versus 612.4±101.2 m) than patients without RLD. The present data suggest that in patients with schizophrenia RLD might be associated with metabolic dysfunctions. Further prospective analyses are required to elucidate the complex interrelationships between lung and metabolic functions in patients with schizophrenia.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre KU Leuven, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium.
| | - Michel Probst
- University Psychiatric Centre KU Leuven, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Brendon Stubbs
- School of Health and Social Care, University of Greenwich, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, UK
| | - Andrew Soundy
- Department of Physiotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Amber De Herdt
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Marc De Hert
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, B-3001 Leuven, Belgium
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Schoepf D, Uppal H, Potluri R, Heun R. Physical comorbidity and its relevance on mortality in schizophrenia: a naturalistic 12-year follow-up in general hospital admissions. Eur Arch Psychiatry Clin Neurosci 2014; 264:3-28. [PMID: 23942824 DOI: 10.1007/s00406-013-0436-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/26/2013] [Indexed: 12/12/2022]
Abstract
Schizophrenia is a major psychotic disorder with significant comorbidity and mortality. Patients with schizophrenia are said to suffer more type-2 diabetes mellitus (T2DM) and diabetogenic complications. However, there is little consistent evidence that comorbidity with physical diseases leads to excess mortality in schizophrenic patients. Consequently, we investigated whether the burden of physical comorbidity and its relevance on hospital mortality differed between patients with and without schizophrenia in a 12-year follow-up in general hospital admissions. During 1 January 2000 and 31 June 2012, 1418 adult patients with schizophrenia were admitted to three General Manchester NHS Hospitals. All comorbid diseases with a prevalemce ≥1% were compared with those of 14,180 age- and gender-matched hospital controls. Risk factors, i.e. comorbid diseases that were predictors for general hospital mortality were identified using multivariate logistic regression analyses. Compared with controls, schizophrenic patients had a higher proportion of emergency admissions (69.8 vs. 43.0%), an extended average length of stay at index hospitalization (8.1 vs. 3.4 days), a higher number of hospital admissions (11.5 vs. 6.3), a shorter length of survival (1895 vs. 2161 days), and a nearly twofold increased mortality rate (18.0 vs. 9.7%). Schizophrenic patients suffered more depression, T2DM, alcohol abuse, asthma, COPD, and twenty-three more diseases, many of them diabetic-related complications or other environmentally influenced conditions. In contrast, hypertension, cataract, angina, and hyperlipidaemia were less prevalent in the schizophrenia population compared to the control population. In deceased schizophrenic patients, T2DM was the most frequently recorded comorbidity, contributing to 31.4% of hospital deaths (only 14.4% of schizophrenic patients with comorbid T2DM survived the study period). Further predictors of general hospital mortality in schizophrenia were found to be alcoholic liver disease (OR = 10.3), parkinsonism (OR = 5.0), T1DM (OR = 3.8), non-specific renal failure (OR = 3.5), ischaemic stroke (OR = 3.3), pneumonia (OR = 3.0), iron-deficiency anaemia (OR = 2.8), COPD (OR = 2.8), and bronchitis (OR = 2.6). There were no significant differences in their impact on hospital mortality compared to control subjects with the same diseases except parkinsonism which was associated with higher mortality in the schizophrenia population compared with the control population. The prevalence of parkinsonism was significantly elevated in the 255 deceased schizophrenic patients (5.5 %) than in those 1,163 surviving the study period (0.8 %, OR = 5.0) and deceased schizophrenic patients had significantly more suffered extrapyramidal symptoms than deceased control subjects (5.5 vs. 1.5 %). Therefore patients with schizophrenia have a higher burden of physical comorbidity that is associated with a worse outcome in a 12-year follow-up of mortality in general hospitals compared with hospital controls. However, schizophrenic patients die of the same physical diseases as their peers without schizophrenia. The most relevant physical risk factors of general hospital mortality are T2DM, COPD and infectious respiratory complications, iron-deficiency anaemia, T1DM, unspecific renal failure, ischaemic stroke, and alcoholic liver disease. Additionally, parkinsonism is a major risk factor for general hospital mortality in schizophrenia. Thus, optimal monitoring and management of acute T2DM and COPD with its infectious respiratory complications, as well as the accurate detection and management of iron-deficiency anaemia, of diabetic-related long-term micro- and macrovascular complications, of alcoholic liver disease, and of extrapyramidal symptoms are of utmost relevance in schizophrenia.
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Affiliation(s)
- Dieter Schoepf
- Department of Psychiatry, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany,
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Cheng KY, Lin CY, Chang TK, Lin CCH, Lu TH, Chen SY. Mortality among long-stay patients with schizophrenia during the setting-up of community facilities under the Yuli model. Health Psychol Behav Med 2014; 2:602-612. [PMID: 25750804 PMCID: PMC4346082 DOI: 10.1080/21642850.2014.908717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 03/18/2014] [Indexed: 11/12/2022] Open
Abstract
Objective: Over the past 15 years, Yuli Veterans Hospital (YVH) in Taiwan has developed the Yuli model to reform long-stay care for psychiatric patients. The development of the Yuli model could be divided into pre-early (1998–1999), early (2000–2006) and late (2007–2008) periods according to the setting-up of the community facilities. In the pre-early period, a vocational rehabilitation program was established for psychiatric patients in YVH. In the later periods, the independent living skills training and the program for social reintegration were instituted in the community facilities. This study aimed to evaluate mortality among the long-stay patients with schizophrenia during the three periods. Methods: In all, 2457 patients with schizophrenia who had been hospitalized for at least one year initially were retrospectively followed from 1 January 1998 to 31 December 2008. Compared with the general population in Taiwan, we calculated the age- and sex-specific standardized mortality ratios (SMRs) of those patients by cause of death during the three periods. Results: Most of the patients were male (81.3%). The mean ± SD age of the patients was 57.83 ± 16.95 years. The all-, natural- and unnatural-cause mortalities of the patients were nearly two times greater than those of the general population during the whole study period. Compared with those in the pre-early and early periods, all patients in the late period had the lowest mortality gaps. In the pre-early, early and late periods, the all-cause SMR were 5.40 (95% confidence interval (CI) = 4.27–6.81), 2.90 (95% CI = 2.20–3.79) and 1.17 (95% CI = 0.54–2.22), respectively, for the 50–69-year-old male patients. Nearly half of all the patients who participated the whole comprehensive rehabilitation program belonged to this sex and age group (N = 156, 46.6%). Conclusions: With the setting-up of community facilities for the comprehensive rehabilitation program, the mortality gaps among the 50–69-year-old male patients apparently decreased using the Yuli model.
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Affiliation(s)
- Kan-Yuan Cheng
- Department of Psychiatry, Yuli Veterans Hospital , Yuli , Taiwan, Republic of China
| | - Chih-Yuan Lin
- Department of Psychiatry, Yuli Veterans Hospital , Yuli , Taiwan, Republic of China
| | - Tzu-Kuei Chang
- Department of Public Health, Tzu Chi University , Hualien , Taiwan, Republic of China
| | - Chaucer C H Lin
- Medical Division, Eli Lilly and Company , Taipei , Taiwan, Republic of China ; Department of Psychiatry and Institute of Human Development, Tzu Chi University , Hualien , Taiwan, Republic of China
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Chen Kung University , Tainan , Taiwan, Republic of China
| | - Shu-Yuan Chen
- Department of Public Health, Tzu Chi University , Hualien , Taiwan, Republic of China
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Torres-González F, Ibanez-Casas I, Saldivia S, Ballester D, Grandón P, Moreno-Küstner B, Xavier M, Gómez-Beneyto M. Unmet needs in the management of schizophrenia. Neuropsychiatr Dis Treat 2014; 10:97-110. [PMID: 24476630 PMCID: PMC3897352 DOI: 10.2147/ndt.s41063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists.
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Affiliation(s)
- Francisco Torres-González
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Inmaculada Ibanez-Casas
- Centro de Investigación Biomédica en Red de Salud Mental, University of Granada, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Dinarte Ballester
- Sistema de Saúde Mãe de Deus, Escola Superior de Saúde, Universidade do Vale do Rio dos Sinos, Brazil ; Maristán Network, University of Granada, Granada, Spain
| | - Pamela Grandón
- Department of Psychology, Faculty of Social Sciences, University of Concepcion, Chile ; Maristán Network, University of Granada, Granada, Spain
| | - Berta Moreno-Küstner
- Andalusian Psychosocial Research Group and Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Malaga, Spain ; Maristán Network, University of Granada, Granada, Spain
| | - Miguel Xavier
- Department of Mental Health, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal ; Maristán Network, University of Granada, Granada, Spain
| | - Manuel Gómez-Beneyto
- Centro de Investigación Biomédica en Red de Salud Mental, University of Valencia, Spain ; Maristán Network, University of Granada, Granada, Spain
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Ozbulut O, Genc A, Bagcioglu E, Coskun KS, Acar T, Alkoc OA, Karabacak H, Sener U, Ucok K. Evaluation of physical fitness parameters in patients with schizophrenia. Psychiatry Res 2013; 210:806-11. [PMID: 24113123 DOI: 10.1016/j.psychres.2013.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/09/2013] [Accepted: 09/15/2013] [Indexed: 10/26/2022]
Abstract
The aims of this study were to compare aerobic and anaerobic exercise capacities, pulmonary functions, body composition and fat distribution parameters in patients with schizophrenia and healthy controls and to investigate the associations among these parameters. Sixty (30 male, 30 female) patients with schizophrenia and 60 (30 male, 30 female) healthy controls were included in the study. Maximal aerobic capacity was estimated with the Astrand submaximal exercise protocol, and anaerobic performance was determined with a Wingate test. Body composition was established with a bioelectrical impedance analyzer. Pulmonary function tests, skinfold thickness and body circumference measurements were also carried out. Maximal aerobic capacity, maximal anaerobic power, anaerobic capacity and pulmonary function tests (forced vital capacity and maximal voluntary ventilation) were found to be lower in male and female schizophrenic groups as compared to the controls. Body fat percentage, waist and abdomen circumferences, and waist to hip ratio were found to be higher in female schizophrenic patients than in controls. We suggest that maximal aerobic capacity, maximal anaerobic power, and anaerobic capacity are poor in the schizophrenia patients as compared to healthy controls. Low cardiorespiratory fitness is related to reduced pulmonary function and impaired body composition in schizophrenia patients.
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Affiliation(s)
- Omer Ozbulut
- Department of Psychiatry, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Liao SY, Lin X, Christiani DC. Gene-environment interaction effects on lung function- a genome-wide association study within the Framingham heart study. Environ Health 2013; 12:101. [PMID: 24289273 PMCID: PMC3882096 DOI: 10.1186/1476-069x-12-101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 11/22/2013] [Indexed: 05/19/2023]
Abstract
BACKGROUND Previous studies in occupational exposure and lung function have focused only on the main effect of occupational exposure or genetics on lung function. Some disease-susceptible genes may be missed due to their low marginal effects, despite potential involvement in the disease process through interactions with the environment. Through comprehensive genome-wide gene-environment interaction studies, we can uncover these susceptibility genes. Our objective in this study was to explore gene by occupational exposure interaction effects on lung function using both the individual SNPs approach and the genetic network approach. METHODS The study population comprised the Offspring Cohort and the Third Generation from the Framingham Heart Study. We used forced expiratory volume in one second (FEV1) and ratio of FEV1 to forced vital capacity (FVC) as outcomes. Occupational exposures were classified using a population-specific job exposure matrix. We performed genome-wide gene-environment interaction analysis, using the Affymetrix 550 K mapping array for genotyping. A linear regression-based generalized estimating equation was applied to account for within-family relatedness. Network analysis was conducted using results from single-nucleotide polymorphism (SNP)-level analyses and from gene expression study results. RESULTS There were 4,785 participants in total. SNP-level analysis and network analysis identified SNP rs9931086 (P(interaction) =1.16 × 10(-7)) in gene SLC38A8, which may significantly modify the effects of occupational exposure on FEV1. Genes identified from the network analysis included CTLA-4, HDAC, and PPAR-alpha. CONCLUSIONS Our study implies that SNP rs9931086 in SLC38A8 and genes CTLA-4, HDAC, and PPAR-alpha, which are related to inflammatory processes, may modify the effect of occupational exposure on lung function.
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Affiliation(s)
- Shu-Yi Liao
- Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Xihong Lin
- Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - David C Christiani
- Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
- Harvard Medical School, 665 Huntington Ave, Boston, MA 02115, USA
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Hsu JH, Chien IC, Lin CH, Chou YJ, Chou P. Increased Risk of Chronic Obstructive Pulmonary Disease in Patients with Schizophrenia: A Population-Based Study. PSYCHOSOMATICS 2013. [DOI: 10.1016/j.psym.2012.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chou FHC, Tsai KY, Chou YM. The incidence and all-cause mortality of pneumonia in patients with schizophrenia: a nine-year follow-up study. J Psychiatr Res 2013; 47:460-6. [PMID: 23317876 DOI: 10.1016/j.jpsychires.2012.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/16/2012] [Accepted: 12/19/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study sought to estimate the incidence, all-cause mortality and relative risks for patients with schizophrenia after a pneumonia diagnosis. METHODS The population was identified from the Taiwanese National Health Insurance Research Database (NHIRD) in 1999 and included 59,021 patients with schizophrenia and 236,084 age- and sex-matched control participants without schizophrenia. These participants were randomly selected from the 23,981,020-participant NHIRD, which contain 96% of the entire population. Using the 2000-2008 NIHRD, the incidence and nine-year pneumonia-free survival rate of pneumonia (ICD-9-CM codes 486 and 507.0-507.8) were calculated. RESULTS Over nine years, 6055 (10.26%) patients with schizophrenia and 7844 (3.32%) controls had pneumonia. The pneumonia incidence density was 11.4/1000 person-years among the patients with schizophrenia, who experienced a 3.09-fold increased risk of developing pneumonia. After adjusting for other covariates, the patients with schizophrenia still experienced a 1.77-fold increased risk of developing pneumonia. Although, without adjustment, fewer schizophrenia patients than controls died after having pneumonia (2121 [35.12%] vs. 3497 [44.62%]), after adjusting for other variables, the mortality hazard ratio for patients with schizophrenia was 1.39. CONCLUSIONS During a nine-year follow-up, the likelihood of developing pneumonia and all-cause mortality among patients with schizophrenia was higher than that of the non-schizophrenia group as was the mortality rate. Interestingly, the psychiatric proportion of days covered (PDC) was positively associated with pneumonia (OR: 2.51) but negatively associated with death (HR: 0.72). These findings imply the importance of iatrogenic factors and psychotropic drugs (including their benefits and side effects) and highlight the directions for future studies.
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Affiliation(s)
- Frank Huang-Chih Chou
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
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Tsan JY, Stock EM, Gonzalez JM, Greenawalt DS, Zeber JE, Rouf E, Copeland LA. Mortality and guideline-concordant care for older patients with schizophrenia: a retrospective longitudinal study. BMC Med 2012. [PMID: 23181341 PMCID: PMC3523058 DOI: 10.1186/1741-7015-10-147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Schizophrenia is associated with excess mortality and multimorbidity, which is possibly associated with difficulty in coordinating care for multiple mental and physical comorbidities. We analyzed the receipt by patients with schizophrenia of 11 types of guideline-concordant care and the association of such care with survival. METHODS Guideline-concordant care over an 8-year period (financial years 2002 to 2009) was examined in a nationwide sample of 49,173 male veterans with schizophrenia, who were aged 50 years or older. Administrative databases from the electronic medical record system of the Veterans Health Administration (VA) provided comprehensive measures of patient demographics and medical information. Relying on the 2004 American Psychiatric Association guidelines, patterns in 11 types of care were identified and cluster-analyzed. Care types included cardiovascular, metabolic, weight management, nicotine dependence, infectious diseases, vision, and mental health counseling (individual, family, drugs/alcohol, psychiatric medication, and compensated work therapy). Survival analysis estimated association of care patterns with survival, adjusting for clinical and demographic covariates. RESULTS There was an average of four chronic diseases in addition to schizophrenia in the cohort, notably hypertension (43%) and dyslipidemia (29%). Three longitudinal trajectories (clusters) were identified: 'high-consistent' (averaging 5.4 types of care annually), 'moderate-consistent' (averaging 3.8), and 'poor-decreasing' (averaging 1.9). Most veterans were receiving cardiovascular care (67 to 76%), hepatic and renal function assays (79 to 84%), individual counseling (72 to 85%) and psychiatry consults (66 to 82%), with the proportion receiving care varying by cluster group. After adjustment for age, baseline comorbidity, and other covariates, there was a greater survival rate for those with poor-decreasing care compared with high-consistent care, and for high-consistent compared with moderate-consistent care. CONCLUSIONS Relatively low levels of guideline-concordant care were seen for older VA patients with schizophrenia, and trajectories of care over time were associated with survival in a non-intuitive pattern. The group with the lowest and decreasing levels of care was also the oldest, but nonetheless had the best age-adjusted and other covariate-adjusted survival rates, possibly because they were requiring less care relative to younger, sicker veterans, and thus their comorbidity burden was markedly lower. Notably, in the group with the sickest individuals (that is those with the highest comorbidity scores, who were very disabled), receiving guideline-concordant care was associated with improved survival in adjusted models compared with those patients receiving only moderate levels of care.
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Affiliation(s)
- Jack Y Tsan
- VISN 17 Center of Excellence for Research on Returning War Veterans, Department of Veterans Affairs, 4800 Memorial Drive (151C), Waco, TX 76711, USA.
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Using the patient safety indicators to detect potential safety events among US veterans with psychotic disorders: clinical and research implications. Int J Qual Health Care 2012; 24:321-9. [DOI: 10.1093/intqhc/mzs026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Despite the recent attention to patient safety and quality of care, no prior studies have addressed outcomes of hospitalization for pneumonia among patients with schizophrenia. This study investigated the extent to which clinical outcomes of pneumonia were different among patients with schizophrenia. This study used data from the Taiwan National Health Insurance Research Database. Of the total of 81,599 patients admitted with a principal diagnosis of pneumonia from 2002 to 2004, 949 had previously been admitted with a principal or secondary diagnosis of schizophrenia within the 2 years of their index pneumonia admission. We randomly selected 2847 pneumonia patients matched with the study group in terms of gender, age, year of admission, length of stay, and Charlson Comorbidity Index score as the comparison cohort. Conditional logistic regression models were used for analysis. Findings indicated a higher prevalence of adverse outcomes among patients with schizophrenia. Patients with schizophrenia were independently associated with a 1.81 times greater risk of intensive care unit admission (95% confidence interval [CI] = 1.37-2.40), a 1.37 times greater risk of acute respiratory failure (95% CI = 1.08-1.88), and a 1.34-fold greater risk of mechanical ventilation (95% CI = 1.04-1.92) after adjusting for characteristics of patients, physicians, hospitals, and potential clustering effects. Adjusted odds ratios were further evident among those treated in private hospitals and in regional/district hospitals. Significant barriers to prompt and appropriate medical care for pneumonia persist for patients with schizophrenia. Careful monitoring of physical health and proper integration between psychiatrists and physicians should be stressed to reduce poor clinical outcomes in this vulnerable population.
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Affiliation(s)
- Yi-Hua Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Chen Lin
- Department of Pediatric Infection, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan,To whom correspondence should be addressed; tel: 886-2-2736-1661 ext 3613, fax: 886-2-2378-9788, e-mail:
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DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10:52-77. [PMID: 21379357 PMCID: PMC3048500 DOI: 10.1002/j.2051-5545.2011.tb00014.x] [Citation(s) in RCA: 1448] [Impact Index Per Article: 111.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.
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Frei CR, Mortensen EM, Copeland LA, Attridge RT, Pugh MJV, Restrepo MI, Anzueto A, Nakashima B, Fine MJ. Disparities of care for African-Americans and Caucasians with community-acquired pneumonia: a retrospective cohort study. BMC Health Serv Res 2010; 10:143. [PMID: 20507628 PMCID: PMC2890642 DOI: 10.1186/1472-6963-10-143] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 05/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African-Americans admitted to U.S. hospitals with community-acquired pneumonia (CAP) are more likely than Caucasians to experience prolonged hospital length of stay (LOS), possibly due to either differential treatment decisions or patient characteristics. METHODS We assessed associations between race and outcomes (Intensive Care Unit [ICU] variables, LOS, 30-day mortality) for African-American or Caucasian patients over 65 years hospitalized in the Veterans Health Administration (VHA) with CAP (2002-2007). Patients admitted to the ICU were analyzed separately from those not admitted to the ICU. VHA patients who died within 30 days of discharge were excluded from all LOS analyses. We used chi-square and Fisher's exact statistics to compare dichotomous variables, the Wilcoxon Rank Sum test to compare age by race, and Cox Proportional Hazards Regression to analyze hospital LOS. We used separate generalized linear mixed-effect models, with admitting hospital as a random effect, to examine associations between patient race and the receipt of guideline-concordant antibiotics, ICU admission, use of mechanical ventilation, use of vasopressors, LOS, and 30-day mortality. We defined statistical significance as a two-tailed p RESULTS Of 40,878 patients, African-Americans (n = 4,936) were less likely to be married and more likely to have a substance use disorder, neoplastic disease, renal disease, or diabetes compared to Caucasians. African-Americans and Caucasians were equally likely to receive guideline-concordant antibiotics (92% versus 93%, adjusted OR = 0.99; 95% CI = 0.81 to 1.20) and experienced similar 30-day mortality when treated in medical wards (adjusted OR = 0.98; 95% CI = 0.87 to 1.10). African-Americans had a shorter adjusted hospital LOS (adjusted HR = 0.95; 95% CI = 0.92 to 0.98). When admitted to the ICU, African Americans were as likely as Caucasians to receive guideline-concordant antibiotics (76% versus 78%, adjusted OR = 0.99; 95% CI = 0.81 to 1.20), but experienced lower 30-day mortality (adjusted OR = 0.82; 95% CI = 0.68 to 0.99) and shorter hospital LOS (adjusted HR = 0.84; 95% CI = 0.76 to 0.93). CONCLUSIONS Elderly African-American CAP patients experienced a survival advantage (i.e., lower 30-day mortality) in the ICU compared to Caucasians and shorter hospital LOS in both medical wards and ICUs, after adjusting for numerous baseline differences in patient characteristics. There were no racial differences in receipt of guideline-concordant antibiotic therapies.
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Affiliation(s)
- Christopher R Frei
- The University of Texas at Austin College of Pharmacy, 1 University Station, A1900, Austin, TX 78712, USA
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Eric M Mortensen
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
- VERDICT Research Program, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
| | - Laurel A Copeland
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
- VERDICT Research Program, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
| | - Russell T Attridge
- The University of Texas at Austin College of Pharmacy, 1 University Station, A1900, Austin, TX 78712, USA
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Mary Jo V Pugh
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
- VERDICT Research Program, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
| | - Marcos I Restrepo
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
- VERDICT Research Program, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
| | - Antonio Anzueto
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
| | - Brandy Nakashima
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
- VERDICT Research Program, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, 7180 Highland Drive (151C-H), Pittsburgh, PA 15206, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Abstract
Chronic lung diseases continue to be common and cause significant morbidity and mortality. There is a complex interplay between psychiatric issues and pulmonary diseases. This review aims to summarize the recent literature and advances involving psychiatric aspects of lung diseases, including chronic obstructive pulmonary disease, asthma, restrictive lung disease, and cystic fibrosis. The authors include the latest findings in epidemiology, impact, etiology, screening, and management of psychiatric and pulmonary comorbidity. The relationship between mental health and lung disease, as it is between mental health and other physical illnesses, is multifactorial. Further studies continue to clarify issues and treatment guidelines for this comorbidity.
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Affiliation(s)
- Abhishek Jain
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Postoperative complications in the seriously mentally ill: a systematic review of the literature. Ann Surg 2008; 248:31-8. [PMID: 18580204 DOI: 10.1097/sla.0b013e3181724f25] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the knowledge base on clinical outcomes of surgery among persons diagnosed with serious mental illness. BACKGROUND Despite a burgeoning literature during the last 20 years regarding perioperative risk management, little is known about intraoperative and postoperative complications among patients with schizophrenia and other serious mental illnesses. METHODS A systematic literature search of Medline (1966-August 2007) and review of studies was conducted. Eligible studies were of any design with at least 10 patients diagnosed with serious mental illness, reporting perioperative medical, surgical, or psychiatric complications. RESULTS The search identified 1367 potentially relevant publications; only 12 met eligibility criteria. Of 10 studies of patients with schizophrenia, 9 had fewer than 100 patients, whereas one large retrospective study reported higher rates of postoperative complications among 466 schizophrenia patients compared with 338,257 controls. These studies suggest that patients with schizophrenia, compared with those without mental illness, may have higher pain thresholds, higher rates of death and postoperative complications, and differential outcomes (eg, confusion, ileus) by anesthetic technique. Two studies evaluated outcomes in patients with major depressive disorder and found higher rates of postoperative delirium and postoperative confusion. Both schizophrenia and depression patients experienced more postoperative confusion or delirium when psychiatric medications were discontinued preoperatively. We identified no studies of perioperative outcomes in patients with bipolar or posttraumatic stress disorder. CONCLUSIONS There are few studies of perioperative outcomes in patients with serious mental illness. Future research should assess surgical risks among patients with serious psychiatric conditions using rigorous methods and well-defined clinical outcomes.
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