A population-based cohort study to elucidate temporal relationship between schizophrenia and metabolic syndrome (KCIS no. PSY3)

A Nationwide Analysis on the Impact of Schizophrenia Following Primary Total Knee Arthroplasty: A Matched-Control Analysis of 49,176 Medicare Patients

BACKGROUND

The influence of schizophrenia on total knee arthroplasty (TKA) is limited in the literature. Therefore, the purpose of this study was to investigate whether patients with schizophrenia undergoing primary TKA have (1) longer in-hospital length of stay (LOS); (2) higher readmission rates; (3) higher medical complications; (4) higher implant-related complications; and (5) higher costs of care compared to controls.

METHODS

Patients with schizophrenia undergoing primary TKA were identified within the Medicare claims database. The study group was randomly matched in a 1:5 ratio to controls according to age, sex, and medical comorbidities. The query yielded 49,176 patients with (n = 8,196) and without (n = 40,980) schizophrenia undergoing primary TKA. Primary outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, in addition to day of surgery and 90-day costs of care. A P-value less than .01 was considered statistically significant.

RESULTS

Schizophrenia patients had longer in-hospital LOS (3.73 days vs 3.22 days, P < .0001) and had higher incidence and odds ratios (ORs) of readmission rates (18.26 vs 12.07%; OR: 1.58, P < .0001) compared to controls. Schizophrenia patients had higher incidence and odds of medical (3.23 vs 1.10%; OR: 2.99, P < .0001) and implant-related complications (5.92 vs 3.59%; OR: 1.68, P < .0001) and incurred significantly higher day of surgery ($13,300.58 vs $11,681.77, P < .0001) and 90-day costs of care ($18,222.18 vs $14,845.64, P < .0001).

CONCLUSION

This study demonstrates that patients with schizophrenia have longer in-hospital LOS, higher readmission rates, higher complications, and increased costs of care after primary TKA.

Increased risk for venous thromboembolism among patients with concurrent depressive, bipolar, and schizophrenic disorders

OBJECTIVE

The study aim was to investigate the risk of venous thromboembolism (VTE) in patients with concurrent depressive, bipolar, and schizophrenic disorders.

METHODS

A population-based cohort study was conducted in which information regarding psychiatric illnesses and medical comorbidities in 29,467 patients with concurrent depressive, bipolar, and schizophrenic disorders and regarding 117,868 controls were extracted. We compared the incidence of VTE between the study and control cohorts. Cox proportional hazard regression models were used to analyze the risk of VTE after adjusting for potential confounders, including sex, age, and comorbidities.

RESULTS

Compared with the control cohort, the overall study cohort had a 2.995-fold higher adjusted hazard ratio (aHR) for development of deep vein thrombosis (DVT) and a 2.591-fold higher aHR for development of pulmonary embolism (PE). Moreover, patients with depressive, bipolar, and schizophrenic disorders all exhibited higher aHRs for development of both DVT and PE.

CONCLUSION

The relative risks of DVT and PE were higher in patients with concurrent depressive, bipolar, and schizophrenic disorders than those of the general population. Further research is needed to develop effective prevention strategies for different patient populations.

Metabolic and endocrinal effects of N-desmethyl-olanzapine in mice with obesity: Implication for olanzapine-associated metabolic changes

Clinical use of the antipsychotic drug olanzapine (OLA) is associated with metabolic side effects to variable degrees. N-desmethyl-olanzapine (DMO) is one major metabolite of OLA, but its potential involvement in the metabolic responses remains unclear. Here we examined whether DMO can directly impact the metabolic, endocrinal and inflammatory parameters under conditions of metabolic disturbance. DMO administration (2 mg/kg, i.g.) to high-fat diet induced obesity mice for 4 weeks induced a remarkable loss of body weight and fat mass. DMO improved insulin resistance and energy expenditure in mice, but had no significant effects on dyslipidemia or hepatic steatosis. Moreover, DMO induced morphological changes in the white adipose tissue, accompanied by reduced interleukin-1β (IL-1β) production and increased UCP1 expression. These findings demonstrate that DMO is devoid of the metabolic side effects commonly observed for OLA during obesity, which suggests that the N-desmethyl metabolism may function to regulate the metabolic responses to OLA.

Comorbid diseases as risk factors for incident posttraumatic stress disorder (PTSD) in a large community cohort (KCIS no.PSY4)

Nature disasters and terrorist attacks have occurred globally in recent years. Posttraumatic stress disorder (PTSD) has gained increasing attention, but its incidence and comorbidities in the general population are different from those inside the disaster areas. The present study estimated incident PTSD and comorbid diseases for over a decade in a cohort from a community-based integrated screening program. Factors associated with the incidence of PTSD were analyzed using Cox regression models. PTSD incidence was estimated as 81 per 10⁵ person-years. Incidence was higher in females than in males and one-year increments in age lowered the risk for PTSD by 3%. Adjusting for other factors, cardiovascular heart disease (adjusted hazard ratio (aHR) = 1.45, 95% confidence interval (CI): 1.03–2.04), bipolar disorder (aHR = 1.86, 95% CI: 1.07–3.24) and major depressive disorder (aHR = 7.03, 95% CI: 5.02–9.85) all significantly increased 45%, 86% and 603%, respectively, the risk of developing PTSD. The low rate of people with incident PTSD receiving treatment in this community health screening population implies there is room for improvement in terms of early detection and intervention. Clinical preventive efforts may be made for patients seeking general medical help, especially those with cardiovascular disorders or mood disorders.

A population-based cohort study on deep vein thrombosis and pulmonary embolism among schizophrenia patients

OBJECTIVE

Several risk factors of venous thromboembolism (VTE) and pulmonary embolism (PE) were found in patients with schizophrenia. Therefore, we hypothesize that the incidences of VTE and PE are relatively higher among schizophrenia patients in comparison with the general population.

METHOD

For this population-based cohort study, claims data from 1996 to 2011 were obtained from the National Health Insurance Research Database in Taiwan. We compared the incidence of DVT and PE between schizophrenia and non-schizophrenia cohorts. Cox proportional hazard regression models were used to analyze the risk of DVT and PE, according to sex, age, and comorbidities.

RESULTS

Compared with the non-schizophrenia cohort, the schizophrenia cohort exhibited a 2.02-fold higher adjusted hazard ratio (HR) for developing DVT, and a 1.99-fold higher adjusted HR for developing PE. Furthermore, schizophrenia patients using first-generation or second-generation antipsychotics exhibited a higher adjusted HR for both DVT and PE development.

CONCLUSION

Compared with the general population, the risk of DVT and PE is relatively higher among schizophrenia patients. Early diagnosis and intervention by physicians could mitigate complications and reduce mortality resulting from VTE.