https://onlinelibrary.wiley.com/doi/pdf/10.1002/j.2051-5545.2011.tb00014.x

Physical illness in patients with severe mental disorders.I. Prevalence, impact of medications and disparities in health care

Antipsychotic medications can induce cardiovascular and metabolic abnormalities (such as obesity, hyperglycemia, dyslipidemia and the metabolic syndrome) that are associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease. Controversy remains about the contribution of individual antipsychotic drugs to this increased risk and whether they cause sudden cardiac death through prolongation of the corrected QT interval. Although some drug receptor-binding affinities correlate with specific cardiovascular and metabolic abnormalities, the exact pharmacological mechanisms underlying these associations remain unclear. Antipsychotic agents with prominent metabolic adverse effects might cause abnormalities in glucose and lipid metabolism via both obesity-related and obesity-unrelated molecular mechanisms. Despite existing guidelines and recommendations, many antipsychotic-drug-treated patients are not assessed for even the most easily measurable metabolic and cardiac risk factors, such as obesity and blood pressure. Subsequently, concerns have been raised over the use of these medications, especially pronounced in vulnerable pediatric patients, among whom their use has increased markedly in the past decade and seems to have especially orexigenic effects. This Review outlines the metabolic and cardiovascular risks of various antipsychotic medications in adults and children, defines the disparities in health care and finally makes recommendations for screening and monitoring of patients taking these agents.

Metabolic and cardiovascular adverse effects associated with antipsychotic drugs

Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality as well as possible ways to reduce it. Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may not have seen the same improvement in life expectancy as the general population during the past decades. Thus, the mortality gap not only persists but may actually have increased. The most urgent research agenda concerns primary candidates for modifiable risk factors contributing to this excess mortality, i.e., side effects of treatment and lifestyle factors, as well as sufficient prevention and treatment of physical comorbidity.

Excess Early Mortality in Schizophrenia

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20384

Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

BACKGROUND: Excess mortality among patients with severe mental disorders has not previously been investigated in detail in large complete national populations. OBJECTIVE: To investigate the excess mortality in different diagnostic categories due to suicide and other external causes of death, and due to specific causes in connection with diseases and medical conditions. METHODS: In longitudinal national psychiatric case registers from Denmark, Finland, and Sweden, a cohort of 270,770 recent-onset patients, who at least once during the period 2000 to 2006 were admitted due to a psychiatric disorder, were followed until death or the end of 2006. They were followed for 912,279 person years, and 28,088 deaths were analyzed. Life expectancy and standardized cause-specific mortality rates were estimated in each diagnostic group in all three countries. RESULTS: The life expectancy was generally approximately 15 years shorter for women and 20 years shorter for men, compared to the general population. Mortality due to diseases and medical conditions was increased two- to three-fold, while excess mortality from external causes ranged from three- to 77-fold. Mortality due to diseases and medical conditions was generally lowest in patients with affective disorders and highest in patients with substance abuse and personality disorders, while mortality due to suicide was highest in patients with affective disorders and personality disorders, and mortality due to other external causes was highest in patients with substance abuse. CONCLUSIONS: These alarming figures call for action in order to prevent the high mortality. Language: en

/pdf/excess-mortality-causes-of-death-and-life-expectancy-in-270-140yj1gp5c.pdf

Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden

Objective: Adverse effects from medication vary with age. Weight gain with several psychotropics is well known in adults but less information is available related to extent and complications of psychotropic-induced weight gain in older psychiatric patients. We determined the relative incidence of 2 obesity-related conditions (diabetes and hypertension) in older psychiatric patients receiving antipsychotics, antidepressants, and mood stabilizers.

https://journals.sagepub.com/doi/pdf/10.1177/070674370905400408

An Epidemiologic Study of Psychotropic Medication and Obesity-Related Chronic Illnesses in Older Psychiatric Patients

Objective: Some studies suggest a higher case fatality from colorectal cancer (CRC) in psychiatric patients even though the incidence is no greater than in the general population. However, this finding is not universal and may be confounded by study design (for example, inception, compared with historical, cohort), mean cohort age, or delays in presentation with more advanced staging at diagnosis. We assessed how study design and cancer stage at presentation affected outcomes in psychiatric patients.

https://espace.library.uq.edu.au/view/UQ:277138/UQ277138_OA.pdf

The effect of study design on the reporting of mortality due to colorectal cancer in adults with mental illness in Nova Scotia.

Does inequitable access to cardiological or neurological procedures contribute to preventable mortality in people with mental illness

Background: Although universal health care aims for equity in service delivery, socioeconomic status still affects death rates from ischemic heart disease and stroke as well as access to revascularization procedures. We investigated whether psychiatric status is associated with a similar pattern of increased mortality but reduced access to procedures. We measured the associations between mental illness, death, hospital admissions and specialized or revascularization procedures for circulatory disease (including ischemic heart disease and stroke) for all patients in contact with psychiatric services and primary care across Nova Scotia. Methods: We carried out a population-based record-linkage analysis of related data from 1995 through 2001 using an inception cohort to calculate rate ratios compared with the general public for each outcome ( n = 215 889). Data came from Nova Scotia9s Mental Health Outpatient Information System, physician billings, hospital discharge abstracts and vital statistics. We estimated patients9 income levels from the median incomes of their residential neighbourhoods, as determined in Canada9s 1996 census. Results: The rate ratio for death of psychiatric patients was significantly increased (1.34), even after adjusting for potential confounders, including income and comorbidity (95% confidence interval [CI] 1.29–1.40), which was reflected in the adjusted rate ratio for first admissions (1.70, 95% CI 1.67–1.72). Their chances of receiving a procedure, however, did not match this increased risk. In some cases, psychiatric patients were significantly less likely to undergo specialized or revascularization procedures, especially those who had ever been psychiatric inpatients. In the latter case, adjusted rate ratios for cardiac catheterization, percutaneous transluminal coronary angioplasty and coronary artery bypass grafts were 0.41, 0.22 and 0.34, respectively, in spite of psychiatric inpatients9 increased risk of death. Conclusions: Psychiatric status affects survival with and access to some procedures for circulatory disease, even in a universal health care system that is free at the point of delivery. Understanding how these disparities come about and how to reduce them should be a priority for future research.

/pdf/inequitable-access-for-mentally-ill-patients-to-some-2uyrmvxfr4.pdf

Inequitable access for mentally ill patients to some medically necessary procedures

Objective: Among mental health outcome measures that have been developed for routine use, most of the information concerns the Health of the Nation Outcome Scales (HoNOS). This instrument is widely used in Europe, Australia, and New Zealand, but not in Canada. We tested its sensitivity and predictive validity under conditions that would resemble, as closely as possible, routine use. Method: Treating clinicians were asked to assess patients of all ages referred to outpatient mental health facilities of 2 district health authorities in Nova Scotia using either the HoNOS for adults or the HoNOS for Children and Adolescents (HoNOSCA). Data were entered using the existing routine administrative data system. Results: We obtained at least 1 rating on 4620 patients, giving a completion rate of 82%. On follow-up, ratings for the global score and most of the individual items were sensitive to change (n = 808). After adjusting for confounders, a baseline HoNOS score was significantly associated with subsequent in and outpatient service use including admissions, bed days, and psychiatric contacts (n = 1359). Conclusions: HoNOS has satisfactory sensitivity and predictive validity for routine use. We could introduce the adult version and HoNOSCA simultaneously and collect data using routine databases. Given the widespread routine use of HoNOS internationally, using the same outcome measure in Canada would enable comparisons of illness severity and outcomes between jurisdictions.

https://journals.sagepub.com/doi/pdf/10.1177/070674371005500706

Do the Health of the Nation Outcome Scales measure outcome

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