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Schizophrenia, neuroleptic medication and mortality

Published online by Cambridge University Press:  02 January 2018

Matti Joukamaa*
Affiliation:
Tampere School of Public Health, University of Tampere and Department of Psychiatry Tampere University Hospital, Tampere
Markku Heliövaara
Affiliation:
National Public Health Institute, Helsinki
Paul Knekt
Affiliation:
National Public Health Institute, Helsinki
Arpo Aromaa
Affiliation:
National Public Health Institute, Helsinki
Raimo Raitasalo
Affiliation:
Social Insurance Institution, Helsinki
Ville Lehtinen
Affiliation:
National Research and Development Centre for Welfare and Health, Helsinki, Finland
*
Dr Matti Joukamaa, Department of Social Psychiatry, Tampere School of Public Health, University of Tampere, FIN-33014, Finland. E-mail: matti.joukamaa@uta.fi
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Abstract

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Background

There is an excess of death from natural causes among people with schizophrenia.

Aims

Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample of 7217 Finns aged ⩾30 years.

Method

A comprehensive health examination was carried out at baseline. Schizophrenia was determined using the Present State Examination and previous medical records.

Results

During a 17-year follow-up, 39 of the 99 people with schizophrenia died. Adjusted for age and gender, the relative mortality risk between those with schizophrenia and others was 2.84 (95% CI 2.06–3.90), and was2.25 (95%CI1.61–3.15) after further adjusting for somatic diseases, blood pressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education. The number of neuroleptics used at the time of the baseline survey showed a graded relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk factors for premature death, the relative risk was 2.50 (95% CI1.46–4.30) per increment of one neuroleptic.

Conclusions

There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Type
Papers
Copyright
Copyright © 2006 The Royal College of Psychiatrists 

Footnotes

See invited commentary, p. 128, this issue.

Declaration of Interest

None.

References

Aromaa, A., Heliovaara, M., Impivaara, O., et al (1989) Aims, methods and study population. Part I. In The Execution of the Mini-Finland Health Survey (eds Aromaa, A., Heliovaara, M., Impivaara, O., et al). Publication no. ML: 88. He sinki: Socia Insurance Institution.Google Scholar
Bralet, M. C., Yon, V., Loas, G., et al (2000) Causes de la mortalité chez les schizophrènes: étude prospective sur 8 ans d'une cohorte de 150 schizophrenes chroniques. Encéphale, 26, 3241.Google Scholar
Brown, S. (1997) Excess mortality of schizophrenia. A meta-analysis. British Journal of Psychiatry, 171, 502508.CrossRefGoogle ScholarPubMed
Brown, S., Inskip, H. & Barraclough, B. (2000) Causes of the excess mortality of schizophrenia. British Journal of Psychiatry, 177, 212217.Google Scholar
Cox, D. R. (1972) Regression models and life-tables. Journal of the Royal Statistical Society B, 34, 187220.Google Scholar
Goldberg, D. P. (1972) The Detection of Psychiatric Illness by Questionnaire. Maudsley Monograph 21. London: Oxford University Press.Google Scholar
Harris, E. C. & Barraclough, B. (1998) Excess mortality of mental disorder. British Journal of Psychiatry, 173, 1153.CrossRefGoogle ScholarPubMed
Heilä, H. & Lonnqvist, J. (2003) The clinical epidemiology of suicide in schizophrenia. In The Epidemiology of Schizophrenia (eds Murray, R., Jones, P., Susser, E., et al), pp. 288316. Cambridge: Cambridge University Press.Google Scholar
Joseph, K. S., Blais, L., Ernst, P., et al (1996) Increased morbidity and mortality related to asthma among asthmatic patients who use major tranquillisers. BMJ, 31, 7982.CrossRefGoogle Scholar
Joukamaa, M., Heliovaara, M., Knekt, P., et al (2001) Mental disorders and cause-specific mortality. British Journal of Psychiatry, 179, 498502.CrossRefGoogle ScholarPubMed
Lehtinen, V., Joukamaa, M., Jyrkinen, E., et al (1990a) Prevalence of mental disorders among adults in Finland. Basic results from the Mini-Finland Health Survey. Acta Psychiatrica Scandinavica, 81, 418425.CrossRefGoogle ScholarPubMed
Lehtinen, V., Joukamaa, M., Jyrkinen, E., et al (1990b) Need for mental health services of the adult population in Finland: results from the Mini-Finland Health Survey. Acta Psychiatrica Scandinavica, 81, 426431.CrossRefGoogle ScholarPubMed
Mäkelä, M., Heliövaara, M., Sievers, K., et al (1993) Musculoskeletal disorders as determinants of disability in Finns aged 30 years or more. Journal of Clinical Epidemiology, 46, 549559.CrossRefGoogle ScholarPubMed
Montout, C., Casadebaig, F., Lagnaoui, R., et al (2002) Neuroleptics and mortalityin schizophrenia: prospective analysis of deathsin a French cohort of schizophrenic patients. Schizophrenia Research, 57, 147156.Google Scholar
Mortensen, P. B. (2003) Mortalityand physical illnessin schizophrenia. In The Epidemiology of Schizophrenia (eds Murray, R., Jones, P., Susser, E., et al), pp. 275287. Cambridge: Cambridge University Press.Google Scholar
Osby, U., Correia, N., Brandt, L., et al (2000) Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophrenia Research, 45, 2128.CrossRefGoogle ScholarPubMed
Ray, W. A. & Meador, K. G. (2002) Antipsychotics and sudden death: is thioridazine the only bad actor? British Journal of Psychiatry, 180, 483484.CrossRefGoogle ScholarPubMed
Ray, W. A., Meredith, S., Thapa, P. B., et al (2001) Antipsychotics and the risk of sudden cardiac death. Archives of General Psychiatry, 58, 11611167.Google Scholar
SAS Institute (1997) SAS/STAT Software: Changes and Enhancements through Release 612. Cary, NC: SAS Institute.Google Scholar
Thomassen, R., Vandenbroucke, J. P. & Rosendaal, F. R. (2001) Antipsychotic medication and venous thrombosis. British Journal of Psychiatry, 179, 6366.Google Scholar
Vaisanen, E. (1975) Psychiatric disorders in Finland. Acta Psychiatrica Scandinavica Supplementum, 263, 2233.Google Scholar
Waddington, J. L., Youssef, H. A. & Kinsella, A. (1998) Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. British Journal of Psychiatry, 173, 325329.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. London: Cambridge University Press.Google Scholar
Wing, J. K., Mann, S. A., Leff, J. P., et al (1978) The concept of a case in psychiatric population surveys. Psychological Medicine, 8, 203217.Google Scholar
Wirshing, D. A., Pierre, J. M., Erhart, S. M., et al (2003) Understanding the new and evolving profile of adverse drug effects in schizophrenia. Psychiatric Clinics of North America, 26, 165190.CrossRefGoogle ScholarPubMed
Witchel, H. J., Hancox, J. C. & Nutt, D. J. (2003) Psychotropic drugs, cardiac arrhythmia, and sudden death. Journal of Clinical Psychopharmacology, 23, 5877.Google Scholar
World Health Organization (1974) Eighth Revision of the International Classification of Diseases and Related Health Problems (ICD-8). Geneva: WHO.Google Scholar
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