Schizophrenia: Medical Illness, Mortality, and Aging

Casey, David; Rodríguez, Mauricio; Northcott, Colleen J.; Vickar, Garry; Shihabuddin, Lina

doi:10.2190/pm.41.3.c

Cited by 47 publications

(34 citation statements)

References 21 publications

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“…The European Psychiatric Association has called for increased cooperation and shared care between the different healthcare professionals to screen and treat CVD-risk factors and diabetes (190). Improved coordination between caretakers and health care professionals is supported by others (190, 191). To obtain an integrated system of care based on a holistic biopsychosocial patient perspective perhaps a complete transformation and reorganization of the current mental health care systems is needed (192).…”

Section: Discussionmentioning

confidence: 99%

Increased Mortality in Schizophrenia Due to Cardiovascular Disease â€“ A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

et al. 2014

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Background: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed.Methods: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors’ experience from clinical work and research in the field.Results: In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population.Discussion: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

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Section: Discussionmentioning

confidence: 99%

Increased Mortality in Schizophrenia Due to Cardiovascular Disease â€“ A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

et al. 2014

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“…Other factors with the potential to affect daytime sleepiness, such as obstructive sleep apnea, obesity, tobacco smoking, and medication(s) for medical diseases, have never been studied. Psychiatric and medical comorbidities in patients with a psychotic disorder or a mood disorder are commonly high [106][107][108]. The severity of symptoms with depression and anxiety can also affect daytime sleepiness.…”

Section: Management Of Somnolence Based On Psychiatric Diagnoses and mentioning

confidence: 99%

Antipsychotic Drug-Induced Somnolence: Incidence, Mechanisms, and Management

et al. 2016

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Somnolence is a common side effect of antipsychotics. To assess the incidence of this side effect, we performed a MEDLINE search for randomized, double-blinded, placebo- or active-controlled studies of adult patients treated with antipsychotics for schizophrenia, mania, bipolar depression, or bipolar disorder. We extracted rates of somnolence from original publications and pooled them based on the dose of each antipsychotic in the same psychiatric condition, then estimated the absolute risk increase (ARI) and the number needed to harm (NNH) of an antipsychotic relative to placebo or an active comparator in the same psychiatric condition. According to the ARI in acute schizophrenia, bipolar mania, and bipolar depression, antipsychotics can be classified as high somnolence (clozapine), moderate somnolence (olanzapine, perphenazine, quetiapine, risperidone, ziprasidone), and low somnolence (aripiprazole, asenapine, haloperidol, lurasidone, paliperidone, cariprazine). The risk of somnolence with blonanserin, brexpiprazole, chlorpromazine, iloperidone, sertindole, and zotepine needs further investigation. The rates of somnolence were positively correlated to dose and duration for some antipsychotics, but not for others. Many factors, including antipsychotic per se, the method used to measure somnolence, patient population, study design, and dosing schedule, might affect the incidence of antipsychotic-induced somnolence. The mechanisms of antipsychotic-induced somnolence are likely multifactorial, although the blockade of histamine 1 receptors and α1 receptors may play a major role. The management of antipsychotic-induced somnolence should include sleep hygiene education, choosing an antipsychotic with a lower risk for somnolence, starting at a lower dose with a slower titration based on psychiatric diagnoses, adjusting doses when necessary, and minimizing concurrent somnolence-prone agents. Since most cases of somnolence were mild to moderate, allowing tolerance to develop over at least 4 weeks is reasonable before discontinuing an antipsychotic.

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“…People with schizophrenia have a lifespan that is shortened by an average 28.5 years, 4 and the elevated rate of smoking is a major contributing factor to this decreased life expectancy. 5,6 Moreover, smoking is a considerable financial burden to patients with schizophrenia 7 and interferes with maintenance of stable levels of some antipsychotic medications. [8][9][10][11] Therefore, cigarette smoking poses considerable risks to people with schizophrenia, making smoking cessation in this population a high public health priority.…”

Section: Introductionmentioning

confidence: 99%

Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial

Brody

Zorick

Hubert

et al. 2016

NICTOB

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Introduction: The majority of people with schizophrenia have a diagnosis of tobacco dependence during their lifetime. A major obstacle to reducing the burden of cigarette smoking in this population is that these smokers have lower quit rates when undergoing standard treatment compared to smokers with no mental illness. We sought to determine if combination extended treatment (COMB-EXT) and home visits (HV) would lead to improved outcomes in smokers with schizophrenia. Methods: Thirty-four cigarette smokers with schizophrenia completed either COMB-EXT with HV, COMB-EXT without HV, or treatment as usual (TAU) (random assignment). COMB-EXT consisted of group cognitive-behavioral therapy (CBT), bupropion, nicotine patch, and nicotine lozenge, which were initiated within 2 weeks and continued for 26 weekly visits. HV consisted of biweekly visits to the home with assessment of secondhand smoke (SHS) exposure and brief behavioral therapy with participants and others in the home environment. TAU consisted of group CBT plus serial single or combination medication trials as per standard care. Results: Smokers with schizophrenia who received COMB-EXT (with or without HV) had greater reductions in cigarettes per day than those treated with TAU (both ps < .01). In addition, 7-day point prevalence abstinence rates for the three groups were 45%, 20%, and 8%, respectively, which was significantly higher for COMB-EXT plus HV than TAU (χ 2 (1) = 4.8, p = .03). Groups did not differ significantly in the number of adverse events, and HV were easily scheduled. Conclusion: COMB-EXT improves outcomes for smokers with schizophrenia. HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population. Implications: The clear benefit found here of rapidly initiated, combination, extended treatment over TAU suggests that aggressive and extended treatment should be considered in clinical practice for smokers with schizophrenia. Furthermore, HV to address SHS exposure showed initial promise for assisting smokers with schizophrenia in maintaining abstinence, indicating that this intervention may be worthy of future research.

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Schizophrenia: Medical Illness, Mortality, and Aging

Cited by 47 publications

References 21 publications

Increased Mortality in Schizophrenia Due to Cardiovascular Disease â€“ A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

Increased Mortality in Schizophrenia Due to Cardiovascular Disease â€“ A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

Antipsychotic Drug-Induced Somnolence: Incidence, Mechanisms, and Management

Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial

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