OBJECTIVE
The objective of this study is to describe secular trends in the average age of death in patients with schizophrenia and to compare these with the general population.


METHODS
This is a longitudinal linkage study from 1 January 1980 to 31 December 2010 using the Danish Psychiatric Research Register and the Danish Cause of Death Register. Data were analyzed using descriptive statistics and survival analysis.


RESULTS
The average age of death in the schizophrenia population (62.2 years; 95% CI, 61.9-62.5) was lower compared to the general population (73.4 years; 95% CI, 73.4-73.4), P<0.001. In the general population we found, for men, an average increase in the age of death of 0.28 years (95% CI, 0.27-0.28) per calendar year, and for women an increase in age of death of 0.31 years (95% CI, 0.31-0.32) per calendar year (both P<0.001). In contrast, age of death decreased in the schizophrenia population: the change in average age of death for males was 0.04 years (95% CI, -0.09 to 0.00) per calendar year (P<0.05), and the comparable estimate for females was -0.05 years (95% CI, -0.09 to 0.01) per calendar year (P<0.05). A similar pattern existed after acts of self-harm as cause of death were excluded from the analyses. Patients diagnosed with schizophrenia had an increased mortality rate compared with the general population (hazard ratio, 2.05; 95% CI, 2.01-2.09).


CONCLUSIONS
On average, patients with schizophrenia die younger than the general population, independent of intentional self-harm as cause of death.

Increasing Mortality Gap for Patients Diagnosed with Schizophrenia

Unrecognized myocardial infarction

Aim:The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP.Methods:A comprehensive literature search identified 28 articles that reported data on AP-specific weight or BMI change in FEP. We conducted a meta-analysis of short- and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs.Results:Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associ...

Antipsychotic-Induced Weight Gain in First-Episode Psychosis Patients: A Meta-Analysis of Differential Effects of Antipsychotic Medications

Background 

People with mental disorders evince excess mortality due to natural and unnatural deaths. The relative life expectancy of people with mental disorders is a proxy measure of effectiveness of social policy and health service provision.

Aims 

To evaluate trends in health outcomes of people with serious mental disorders.

Method 

We examined nationwide 5-year consecutive cohorts of people admitted to hospital for mental disorders in Denmark, Finland and Sweden in 1987–2006. In each country the risk population was identified from hospital discharge registers and mortality data were retrieved from cause-of-death registers. The main outcome measure was life expectancy at age 15 years.

Results 

People admitted to hospital for a mental disorder had a two- to threefold higher mortality than the general population in all three countries studied. This gap in life expectancy was more pronounced for men than for women. The gap decreased between 1987 and 2006 in these countries, especially for women. The notable exception was Swedish men with mental disorders. In spite of the positive general trend, men with mental disorders still live 20 years less, and women 15 years less, than the general population.

Conclusions 

During the era of deinstitutionalisation the life expectancy gap for people with mental disorders has somewhat diminished in the three Nordic countries. Our results support further development of the Nordic welfare state model, i.e. tax-funded community-based public services and social protection. Health promotion actions, improved access to healthcare and prevention of suicides and violence are needed to further reduce the life expectancy gap.

Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders

Objectives Little is known about service utilisation by patients with severe mental illness (SMI) in UK primary care. We examined their consultation rate patterns and whether they were impacted by the introduction of the Quality and Outcomes Framework (QOF), in 2004. Design Retrospective cohort study using individual patient data collected from 2000 to 2012. Setting 627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database. Participants SMI cases (346 551) matched to 5 individuals without SMI (1 732 755) on age, gender and general practice. Outcome measures Consultation rates were calculated for both groups, across 3 types: face-to-face (primary outcome), telephone and other (not only consultations but including administrative tasks). Poisson regression analyses were used to identify predictors of consultation rates and calculate adjusted consultation rates. Interrupted time-series analysis was used to quantify the effect of the QOF. Results Over the study period, face-to-face consultations in primary care remained relatively stable in the matched control group (between 4.5 and 4.9 per annum) but increased for people with SMI (8.8–10.9). Women and older patients consulted more frequently in the SMI and the matched control groups, across all 3 consultation types. Following the introduction of the QOF, there was an increase in the annual trend of face-to-face consultation for people with SMI (average increase of 0.19 consultations per patient per year, 95% CI 0.02 to 0.36), which was not observed for the control group (estimates across groups statistically different, p=0.022). Conclusions The introduction of the QOF was associated with increases in the frequency of monitoring and in the average number of reported comorbidities for patients with SMI. This suggests that the QOF scheme successfully incentivised practices to improve their monitoring of the mental and physical health of this group of patients.

Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Database

Individuals with schizophrenia or substance use disorder have a substantially increased mortality compared to the general population. Despite a high and probably increasing prevalence of comorbid substance use disorder in people with schizophrenia, the mortality in the comorbid group has been less studied and with contrasting results. We performed a nationwide open cohort study from 2009 to 2015, including all Norwegians aged 20–79 with schizophrenia and/or substance use disorder registered in any specialized health care setting in Norway, a total of 125,744 individuals. There were 12,318 deaths in the cohort, and total, sex-, ageand cause-specific standardized mortality ratios (SMRs) were calculated, comparing the number of deaths in patients with schizophrenia, schizophrenia only, substance use disorder only or a co-occurring diagnosis of schizophrenia and substance use disorder to the number expected if the patients had the age-, sexand calendar-year specific death rates of the general population. The SMRs were 4.9 (95% CI 4.7–5.1) for all schizophrenia patients, 4.4 (95% CI 4.2–4.6) in patients with schizophrenia without substance use disorder, 6.6 (95% CI 6.5–6.8) in patients with substance use disorder only, and 7.4 (95% CI 7.0–8.2) in patients with both schizophrenia and substance use disorder. The SMRs were elevated in both genders, in all age groups and for all considered causes of death, and most so in the youngest. Approximately 27% of the excess mortality in all patients with schizophrenia was due to the raised mortality in the subgroup with comorbid SUD. The increased mortality in patients with schizophrenia and/or substance use disorder corresponded to more than 10,000 premature deaths, which constituted 84% of all deaths in the cohort. The persistent mortality gap highlights the importance of securing systematic screening and PLOS ONE | https://doi.org/10.1371/journal.pone.0202028 August 23, 2018 1 / 17 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPENACCESS Citation: Heiberg IH, Jacobsen BK, Nesvåg R, Bramness JG, Reichborn-Kjennerud T, Næss Ø, et al. (2018) Total and cause-specific standardized mortality ratios in patients with schizophrenia and/ or substance use disorder. PLoS ONE 13(8): e0202028. https://doi.org/10.1371/journal. pone.0202028 Editor: Chin-Kuo Chang, Institute of Psychiatry, UNITED KINGDOM Received: December 20, 2017 Accepted: July 26, 2018 Published: August 23, 2018 Copyright: © 2018 Heiberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Confidentiality requirements according to Norwegian law prevents sharing of individual patient level data in public repositories. Application of legal basis and exemption from professional secrecy requirements for the use of personal health data in research may be sent to a regional committee for medical and health research ethics (https://helseforskning. etikkom.no/), and requests for the data to The Norwegian Patient Registry (https:// helsedirektoratet.no/English) and the Cause of proper access to somatic health care, and a more effective prevention of premature death from external causes in this group. Introduction Individuals with schizophrenia have a twoto three-fold increased mortality compared to the general population [1–3] and a 10-20-year reduction in average life span [2, 4–6]. Individuals with substance use disorder (SUD) have an even higher risk of premature death, ranging from a four-fold increased mortality among persons with alcohol use disorder (AUD) [7–10] to a four to-15-fold increased mortality among opioid users [11–13]. A concurrent diagnosis of schizophrenia spectrum disorder (SCZ) and SUD (henceforth referred to as SCZ+SUD) is associated with a variety of detrimental outcomes, among these increased somatic morbidity [14–19], increased risk of fatal overdoses, violent behavior [20–23] and victimization [24, 25]. Despite these vulnerabilities and a high [26, 27], and probably increasing [28], prevalence of comorbid SUD in SCZ patients, the mortality in the comorbid group has been less studied and with contrasting results. Studies of SCZ individuals with co-morbid SUD have found both increased [29–34] and decreased [35] all-cause mortality, increased suicide mortality [36, 37], but no difference in cardiovascular mortality [38] compared to SCZ individuals without SUD. Studies of SUD individuals report both higher [39, 40], similar [12, 13, 40–43], and lower [44] mortality in individuals also diagnosed with a psychotic disorder, compared to individuals with SUD-only, depending on type of SUD and gender [40]. Only a few studies with complete national coverage have investigated all cause [30, 33, 34, 40] or cause-specific mortality [33, 34] in patients with SCZ-only, SUD-only or co-morbid SCZ and SUD, and neither of these reported results for different age groups or mortality from unnatural causes of death. The aims of the present study were to (i) investigate standardized mortality ratios for all cause mortality (SMRs) in patients with SCZ, SCZ-only, SUD-only and SCZ+SUD, diagnosed in Norwegian psychiatric or somatic specialist health care, (ii) describe how much of the excess mortality that could be attributed to a concurrent diagnosis of SCZ and SUD, and (iii) investigate age-, sex-, and cause-specific SMRs in patients with SCZ-only, SUD-only or SCZ+SUD. We hypothesized that mortality in patients with SCZ and/or SUD would be increased compared to the general population for all main causes of death, and that patients with a concurrent diagnosis of SCZ and SUD would have particularly high SMRs. Materials and methods Study population The study population included all inand outpatients diagnosed with SCZ and/or SUD in the Norwegian specialized health care system during 2009–2015, who were 20–79 years old when they had their first consultation in the time bracket. Patients with SCZ and/or SUD were identified through the Norwegian Patient Registry (NPR), which is a mandatory national registry covering all patients receiving specialist health care (i.e. government-owned hospitals and outpatient clinics, publicly financed substance use treatment facilities and private health clinics with governmental reimbursement). Since 2009 the coverage in the NPR is almost 100% [45, 46]. The exception is private mental health clinics with governmental reimbursement, where the proportion of the episodes that were reported to the NPR increased from 76% in 2009 [47] to 97% in 2015 [48], but only 0.2% of patients in the present study were treated solely in these clinics. Patients were excluded if an invalid ID number (n = 6,178), a diagnosis of intellectual Standardized mortality ratios in schizophrenia and/or substance use disorder PLOS ONE | https://doi.org/10.1371/journal.pone.0202028 August 23, 2018 2 / 17 Death Registry (https://www.fhi.no/en/). Information on annual number of deaths by sex, age and cause of death are freely available at http:// statistikkbank.fhi.no/webview, and annual population numbers freely available at http:// statistikkbank.fhi.no. Funding: The study is funded by a research grant offered by the Regional Health Authorities in Northern Norway. Grant number: PFP1236-15. URL: https://helse-nord.no/. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Competing interests: The authors have declared that no competing interests exist. disability (ICD-10 codes F70-F79) (n = 1,632), or inconsistent data regarding age, gender or emigration date (n = 666) were recorded. Diagnostic categories Diagnostic codes in the NPR follow the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) [49]. Patients were included in the SCZ group if a diagnosis of schizophrenia-related disorders (F20-F29) was recorded in the NPR during 2009– 2015. The SUD group included patients with a diagnosis of mental and behavioral disorders due to use of psychoactive substances (F10-F19, excluding tobacco (F17)), and patients with at least one somatic diagnosis strongly indicating alcohol abuse (see list of ICD-10 codes in S1 Table). Patients identified by somatic diagnoses only constituted 4.1% of the SUD group. A total of 275 patients treated in substance use treatment facilities, with a diagnosis of SCZ, but no registered diagnosis of SUD (excluding pathological gambling (F63.0)), were included in the SCZ+SUD group. In subgroup analyses, we differentiated between patients with a nonalcohol SUD (F11-F16, F18-F19, Z50.3, Z71.5 and Z72.2), and patients with AUD only. Hard drug use disorder was deemed present if the patient was diagnosed with disorders due to use of opioids (F11), cocaine (F14), other stimulants (mostly amphetamines, F15), hallucinogens (F16), volatile solvents (F18), and multiple drug use and use of other psychoactive substances (F19). Information on deaths The Cause of Death Registry (CDR), which includes 98% of all deaths in Norway [50], provided data on the underlying cause of death, based on death certificates issued by physicians. The National Population Registry provided information about year of birth and date of death or emigration. Accurate linkage regarding mortality of the patients was obtained using the unique 11 digit personal ID number included in all the registries. Causes of death were coded according to ICD-10 [49] and divided into natural causes (A00-R99), unnatural causes (V01-Y98) and missing cause of death. Natural causes of death were further divided into cardiovascular (I00-I99), respiratory (J00-J99), cancer (C00-C97) and other natural causes. Unnatural 

Mortality, substance use disorder and cardiovascular health care in persons with severe mental illness

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Ina Heidi Heiberg

Author Tools

Chat about Author

Papers

Mortality, substance use disorder and cardiovascular health care in persons with severe mental illness