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Yu TH, Lee TL, Hsuan CF, Wu CC, Wang CP, Lu YC, Wei CT, Chung FM, Lee YJ, Tsai IT, Tang WH. Inter-relationships of risk factors and pathways associated with all-cause mortality in patients with chronic schizophrenia. Front Psychiatry 2024; 14:1309822. [PMID: 38831863 PMCID: PMC11144862 DOI: 10.3389/fpsyt.2023.1309822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/18/2023] [Indexed: 06/05/2024] Open
Abstract
Introduction Of all psychiatric disorders, schizophrenia is associated with the highest risk of all-cause mortality. This study aimed to investigate independent risk factors for all-cause mortality in patients with chronic schizophrenia. In addition, the possible causal inter-relationships among these independent risk factors and all-cause mortality were also explored. Methods We conducted an analysis of 1,126 patients with chronic schizophrenia from our psychiatric department from April 2003 to August 2022, and retrospectively reviewed their medical records. The study endpoint was all-cause mortality. Baseline clinical characteristics including sociodemographic data, biochemical data, lifestyle factors, comorbidities and antipsychotic treatment were examined with Cox proportional hazards analysis. Results The all-cause mortality rate was 3.9% (44 patients). Multivariate Cox regression analysis revealed that several factors were independently associated with all-cause mortality, including diabetes mellitus (DM), hypertension, heart failure, gastroesophageal reflux disease (GERD), peptic ulcer disease, ileus, underweight, fasting glucose, triglycerides, albumin, and hemoglobin. Structural equation modeling (SEM) analysis revealed that several factors had statistically significant direct effects on all-cause mortality. Heart failure, hypertension, underweight, age at onset, and ileus showed positive direct effects, while albumin and hemoglobin demonstrated negative direct effects. In addition, several factors had indirect effects on all-cause mortality. GERD indirectly affected all-cause mortality through ileus, and peptic ulcer disease had indirect effects through albumin and ileus. Ileus, underweight, DM, and hypertension also exhibited indirect effects through various pathways involving albumin, hemoglobin, and heart failure. Overall, the final model, which included these factors, explained 13% of the variability in all-cause mortality. Discussion These results collectively suggest that the presence of DM, hypertension, heart failure, GERD, peptic ulcer disease, ileus, and underweight, along with lower levels of albumin or hemoglobin, were independently associated with all-cause mortality. The SEM analysis further revealed potential causal pathways and inter-relationships among these risk factors contributing to all-cause mortality in patients with chronic schizophrenia.
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Affiliation(s)
- Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chao-Ping Wang
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Yung-Chuan Lu
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Ching-Ting Wei
- Division of General Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | | | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Ashour AA, Fahmi MK, Mohamed RN, Basha S, Binmadi N, Enan ET, Basalim A, Qahatani AA. Association between gastric reflux, obesity and erosive tooth wear among psychiatric patients. Medicine (Baltimore) 2022; 101:e28923. [PMID: 35363217 PMCID: PMC9281915 DOI: 10.1097/md.0000000000028923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/06/2022] [Indexed: 01/04/2023] Open
Abstract
The prevalence of erosive tooth wear and obesity are high in psychiatric patients and soft drink consumption is a common risk factor associated with both diseases. This study aimed to assess the association between soft drink consumption, gastric reflux, erosive tooth wear, and obesity among resident patients at the Psychiatric Hospital, Taif, Saudi Arabia.This descriptive, cross-sectional study included 223 adult psychiatric inpatients (126 male, 97 female) with a mean age of 42.3 years (± 2.2). Dental erosion detection was performed according to World Health Organization criteria. The medical evaluation included assessment of the body mass index (BMI). With appropriate sample weighting, relationships between erosive tooth wear, gastric reflux, and obesity were assessed using multivariable logistic regression.Ninety eight patients (43.9%) presented with erosive tooth wear. The mean BMI for the entire study population was 27.7 ± 6.3 kg/m2. Regression analysis showed a strong association between erosive tooth wear and chronic vomiting or bulimia (adjusted odds ratio = 2.11; 95% confidence interval [CI] = 1.98-5.07, P < .001), gastric reflux (adjusted odds ratio = 2.13; 95% CI = 1.34-6.23, P < .001), consumption of soft drinks (adjusted odds ratio = 2.14; 95% CI = 1.03-6.08, P < .001), and schizophrenia and delusional disorders (adjusted odds ratio = 2.07; 95% CI = 1.98-5.08, P < .001).This study demonstrates a significant association between erosive tooth wear prevalence and chronic vomiting or bulimia, consumption of soft drinks, and gastric reflux among resident patients at psychiatric hospital.
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Affiliation(s)
- Amal Adnan Ashour
- Department of Oral Pathology, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Mohammed Khalil Fahmi
- Department of Restorative Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | | | - Sakeenabi Basha
- Department of Community Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Nada Binmadi
- Department of Oral Diagnostic Science, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Enas Tawfik Enan
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Egypt
| | - Alaa Basalim
- Department of Periodontology, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Abeer Al Qahatani
- Department of Operative Dentistry, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
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Okamoto T, Suzuki H, Fukuda K. Clinical and endoscopic characteristics of acute esophageal necrosis and severe reflux esophagitis. Medicine (Baltimore) 2021; 100:e27672. [PMID: 34871245 PMCID: PMC8568454 DOI: 10.1097/md.0000000000027672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/14/2021] [Indexed: 01/05/2023] Open
Abstract
The similarities and differences between acute esophageal necrosis and severe reflux esophagitis have not been elucidated. We compared Los Angeles classification Grade C reflux esophagitis, Grade D reflux esophagitis, and acute esophageal necrosis to consider the similarities and differences between acute esophageal necrosis and severe reflux esophagitis.We retrospectively reviewed records of patients who underwent esophagogastroduodenoscopy at a tertiary referral center from January 2012 to December 2019. Data on patients diagnosed as Grade C reflux, Grade D reflux, or acute esophageal necrosis for the first time were extracted for analysis.A total of 213 patients were enrolled in the study, composed of 130 Grade C reflux, 74 Grade D reflux, and 9 acute esophageal necrosis patients. Compared to Grade C reflux patients, Grade D reflux and acute esophageal necrosis patients were more likely to be transfused (P = .013 and P = .011, respectively), to have duodenal ulcers (P = .025 and P = .049, respectively), and to have psychiatric illnesses (P = .022 and P = .018, respectively). Compared to both Grade C and D reflux, acute esophageal necrosis patients were more likely to present with shock (P = .003 and P < .001, respectively), have type 1 diabetes (P = .030 and P = .004, respectively), and present in winter (P < .001 and P < .001, respectively). Significant step-wise differences (Grade C < Grade D < acute esophageal necrosis) were observed in the need for admission (P < .001 and P = .009), coffee ground emesis (P < .001 and P = .022), and stigmata of hemorrhage on endoscopy (P = .002 and P < .001). Admission (P = .003) and coffee ground emesis (P = .003) independently predicted either Grade D reflux or acute esophageal necrosis over Grade C reflux on multivariate analysis.Shock, type 1 diabetes, and winter may predict acute esophageal necrosis, while the need for admission and coffee ground emesis may predict Grade D reflux or acute esophageal necrosis.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
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