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Schizophrenia, neuroleptic medication and mortality

  • Matti Joukamaa (a1), Markku Heliövaara (a2), Paul Knekt (a2), Arpo Aromaa (a2), Raimo Raitasalo (a3) and Ville Lehtinen (a4)...
Abstract
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.

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Copyright
Corresponding author
Dr Matti Joukamaa, Department of Social Psychiatry, Tampere School of Public Health, University of Tampere, FIN-33014, Finland. E-mail: matti.joukamaa@uta.fi
Footnotes
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See invited commentary, p. 128, this issue.

Declaration of Interest

None.

Footnotes
References
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The British Journal of Psychiatry
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  • EISSN: 1472-1465
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Schizophrenia, neuroleptic medication and mortality

  • Matti Joukamaa (a1), Markku Heliövaara (a2), Paul Knekt (a2), Arpo Aromaa (a2), Raimo Raitasalo (a3) and Ville Lehtinen (a4)...
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eLetters

A Sobering Thought

Adil Y. Kadri, Psychiatrist
15 February 2006

I enjoyed reading this study on a very important but often neglected area of Psychiatry.

We often see illnesses such as Schizophrenia as just diagnoses and think of our patients in terms of their symptoms and whether or not these have responded to medication or not. Moving through jobs (over the years) we often forget the person behind the illness and what happens to them in the longer term. This study highlights and also serves to remind us of thefact that a significant proportion of our patients with schizophrenia may die in a not so long period of time. For me at least, this is a sobering thought.

The current study appeared to be comprehensive but it would have been interesting to know what the specific causes of death were in this particular sub-group and also the rates of illicit drug use.

The author did list the medications which this sub-group was on (which were mainly the older traditionally used anti-psychotics) but in current practice most psychiatrists would tend to use the newer atypical anti-psychotics. I would therefore wonder, that if medications did contribute to the increased mortality seen in this study then the results may not hold true for current practice. Clinically, this would be a difficult question to answer for the simple reason that the results of a similar study started today for the atypicals may not be applicable in twenty years time time as they may no longer be in use.
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Conflict of interest: None Declared

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