Advertisement

Zeitschrift für Gerontologie und Geriatrie

, Volume 51, Issue 7, pp 777–782 | Cite as

Somatische Risiken bei alt gewordenen Menschen mit schweren psychiatrischen Erkrankungen

  • Daniel Kopf
  • Walter Hewer
Themenschwerpunkt
  • 89 Downloads

Zusammenfassung

Hintergrund

Patienten mit schweren psychiatrischen Erkrankungen („severe mental illness“, SMI) zeichnen sich durch ein hohes Maß an funktioneller Beeinträchtigung, aber auch durch eine hohe somatische Multimorbidität aus. Bislang existieren kaum systematische Untersuchungen zu dieser Patientengruppe in hohem Lebensalter. Der vorliegende Review fasst die wichtigsten somatischen Komorbiditäten zusammen und erwägt Konsequenzen für die Versorgung dieser Patientengruppe im hohen Lebensalter.

Methodik

Selektive Übersichtsarbeit auf der Basis einer PubMed-Recherche, Beobachtungen aus klinischer Praxis

Ergebnisse

Die Lebenserwartung von Menschen mit SMI ist im Mittel um etwa 10 Jahre verkürzt. Grund hierfür sind vor allem somatische Komorbiditäten, insbesondere Lungen- und Atemwegserkrankungen, das metabolische Syndrom mit konsekutiven kardiovaskulären Erkrankungen sowie Osteoporose und Frakturen mit kompliziertem Verlauf. Trotz der verkürzten Lebenserwartung nimmt die Zahl geriatrischer Patienten mit SMI zu und erfordert besondere Aufmerksamkeit bezüglich der ambulanten psychosozialen Versorgung, des Selbstmanagements von somatischen Erkrankungen und der altersadäquaten Fortsetzung der psychiatrischen Behandlung.

Schlussfolgerungen

Menschen mit SMI haben aufgrund ihrer typischen somatischen Komorbidität eine stark verkürzte Lebenserwartung, erreichen aber im Rahmen der allgemein verbesserten Behandlungsmöglichkeiten immer häufiger ein hohes Lebensalter. Sie benötigen häufig besondere Aufmerksamkeit bei der Diagnostik und Unterstützung im Management ihrer Behandlung. Vernetzte internistisch-geriatrische und gerontopsychiatrische Behandlungseinrichtungen sind hilfreich für die notwendige interdisziplinäre Behandlung.

Schlüsselwörter

Komorbidität Lebenserwartung Psychosoziale Versorgung Geriatrische Patienten Schwere psychiatrische Erkrankungen 

Somatic risks in elderly people with severe psychiatric illnesses

Abstract

Background

Aged patients with severe mental illness (SMI) suffer from a high risk for functional impairment and a high load of somatic comorbidities. Until now, there has been a lack of systematic studies on this patient population in later life. This review summarizes the most significant somatic comorbidities and discusses the consequences for the medical care of this elderly group of patients.

Methods

A selective narrative review based on PubMed research and observations in clinical practice.

Results

Life expectancy is shortened by approximately 10 years in patients with SMI. The main reasons are somatic comorbidities, particularly lung and respiratory tract disorders, metabolic syndrome with its subsequent cardiovascular complications, in addition to osteoporosis and fractures with a complicated clinical course. Although life expectancy is shortened, the number of geriatric patients with SMI is increasing and requires special attention to be given to out-patient psychosocial care, self-management of somatic diseases, and to age-appropriate continuation of psychiatric treatment.

Conclusion

The life expectancy of patients with SMI is reduced because of their typically somatic comorbidity, but they are reaching increasingly advanced ages as a consequence of improved treatment possibilities. They often require special attention in their diagnostic work-up and support in the management of their treatment. Collaborative care linking medical geriatric and geronto-psychiatric treatment facilities is helpful in the the interdisciplinary therapy required.

Keywords

Comorbidity Life expectancy Psychosocial nursing Geriatric patients Severe mental illness 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Kopf und W. Hewer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380(9836):37–43CrossRefGoogle Scholar
  2. 2.
    Becker T, Hux J (2011) Risk of acute complications of diabetes among people with schizophrenia in Ontario, Canada. Diabetes Care 34(2):398–402.  https://doi.org/10.2337/dc10-1139 CrossRefGoogle Scholar
  3. 3.
    Davydow DS, Ribe AR, Pedersen HS, Fenger-Grøn M, Cerimele JM, Vedsted P, Vestergaard M (2016) Serious mental illness and risk for hospitalizations and rehospitalizations for ambulatory care-sensitive conditions in Denmark: a nationwide population-based cohort study. Med Care 54(1):90–97.  https://doi.org/10.1097/MLR.0000000000000448 CrossRefGoogle Scholar
  4. 4.
    De Hert M, Correll CU, Bobes J et al (2011) Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10:52–77CrossRefGoogle Scholar
  5. 5.
    De Hert M, Cohen D, Bobes J et al (2011) Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 10:138–151CrossRefGoogle Scholar
  6. 6.
    Golden SH, Lazo M, Carnethon M, Bertoni AG, Schreiner PJ, Diez Roux AV, Lee HB, Lyketsos C (2008) Examining a bidirectional association between depressive symptoms and diabetes. JAMA 299(23):2751–2759.  https://doi.org/10.1001/jama.299.23.2751 CrossRefGoogle Scholar
  7. 7.
    Gomez L, Stubbs B, Shirazi A, Vancampfort D, Gaughran F, Lally J (2016) Lower bone mineral density at the hip and lumbar spine in people with psychosis versus controls: a comprehensive review and skeletal site-specific meta-analysis. Curr Osteoporos Rep 14(6):249–259CrossRefGoogle Scholar
  8. 8.
    Gühne U, Becker T, Salize H‑J, Riedel-Heller SG (2015) Wie viele Menschen in Deutschland sind schwer psychisch krank? Psychiatr Prax 42(2015):415–423Google Scholar
  9. 9.
    Hewer W, Schneider F (2016) Somatische Morbidität bei psychisch Kranken. Nervenarzt 87:787–801CrossRefGoogle Scholar
  10. 10.
    IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2010) Alcohol consumption and ethyl carbamate. IARC monographs on the evaluation of carcinogenic risks in humans, Bd. 96. International Agency for Research on Cancer, Lyon, S 1281–1383Google Scholar
  11. 11.
    Jayatilleke N, Hayes RD, Dutta R, Shetty H, Hotopf M, Chang CK, Stewart R (2017) Contributions of specific causes of death to lost life expectancy in severe mental illness. Eur Psychiatry 43:109–115.  https://doi.org/10.1016/j.eurpsy.2017.02.487 CrossRefGoogle Scholar
  12. 12.
    Jørgensen M, Mainz J, Lange P, Paaske Johnsen S (2018) Quality of care and clinical outcomes of chronic obstructive pulmonary disease in patients with schizophrenia. A Danish nationwide study. Int J Qual Health Care 30(5):351–357.  https://doi.org/10.1093/intqhc/mzy014 CrossRefGoogle Scholar
  13. 13.
    Klement MR, Bala A, Blizzard DJ, Wellman SS, Bolognesi MP, Seyler TM (2016) Should we think twice about psychiatric disease in total hip arthroplasty? J Arthroplasty 31(9 Suppl):221–226.  https://doi.org/10.1016/j.arth.2016.01.063 CrossRefGoogle Scholar
  14. 14.
    Kopf D, Hummel J (2013) Depression beim gebrechlichen Alterspatienten. Diagnostik und Therapie. Z Gerontol Geriatr 46(2):127–133.  https://doi.org/10.1007/s00391-012-0461-9 CrossRefGoogle Scholar
  15. 15.
    Lange-Asschenfeldt C (2018) Psychopharmakotherapie bei älteren Menschenmit schweren psychischen Erkrankungen. Z Gerontol Geriat.  https://doi.org/10.1007/s00391-018-1455-z Google Scholar
  16. 16.
    Lederbogen F, Kopf D, Hewer W (2008) Interdisziplinare Station fur psychisch Kranke mit erheblichen somatischen Komorbiditaten: Konzept und Erfahrungen von 1985–2007. Nervenarzt 79(9):1051–1058.  https://doi.org/10.1007/s00115-008-2474-6 CrossRefGoogle Scholar
  17. 17.
    Mackin RS, Areán PA (2009) Incidence and documentation of cognitive impairment among older adults with severe mental illness in a community mental health setting. Am J Geriatr Psychiatry 17(1):75–82.  https://doi.org/10.1097/JGP.0b013e31818cd3e5 CrossRefGoogle Scholar
  18. 18.
    Mulligan K, McBain H, Lamontagne-Godwin F, Chapman J, Flood C, Haddad M, Jones J, Simpson A (2018) Barriers to effective diabetes management – a survey of people with severe mental illness. BMC Psychiatry 18(1):165.  https://doi.org/10.1186/s12888-018-1744-5 CrossRefGoogle Scholar
  19. 19.
    Muralidharan A, Klingaman EA, Prior SJ, Molinari V, Goldberg RW (2016) Medical and psychosocial barriers to weight management in older veterans with and without serious mental illness. Psychol Serv 13(4):419–427CrossRefGoogle Scholar
  20. 20.
    National Institute of Mental Health (2018) https://www.nimh.nih.gov/health/statistics/mental-illness.shtml. Zugegriffen: 2. Aug. 2018
  21. 21.
    Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS (2015) Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 72(12):1172–1181.  https://doi.org/10.1001/jamapsychiatry.2015.1737 CrossRefGoogle Scholar
  22. 22.
    Osborn DP, Limburg H, Walters K, Petersen I, King M, Green J, Watson J, Nazareth I (2013) Relative incidence of common cancers in people with severe mental illness. Cohort study in the United Kingdom THIN primary care database. Schizophr Res 143(1):44–49.  https://doi.org/10.1016/j.schres.2012.11.009 CrossRefGoogle Scholar
  23. 23.
    Pan CC, Hu LY, Lu T, Tu MS, Shen CC, Chen ZJ (2018) Risk of hip fractures in patients with depressive disorders: A nationwide, population-based, retrospective, cohort study. PLoS One 13(4):e0194961.  https://doi.org/10.1371/journal.pone.0194961
  24. 24.
    Povitz M, Bolo CE, Heitman SJ, Tsai WH, Wang J, James MT (2014) Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. Plos Med 11(11):e1001762CrossRefGoogle Scholar
  25. 25.
    Roberts E, Evins EA, McNeill A, Robson D (2016) Efficacy and tolerability of pharmacotherapy for smoking cessation in adults with serious mental illness: a systematic review and network meta-analysis. Addiction 111(4):599–612.  https://doi.org/10.1111/add.13236 CrossRefGoogle Scholar
  26. 26.
    Ruggeri M, Leese M, Thornicroft G, Bisoffi G, Tansella M (2000) Definition and prevalence of severe and persistent mental illness. Br J Psychiatry 177:149–155CrossRefGoogle Scholar
  27. 27.
    Salzer MS, Brusilovskiy E, Townley G (2018) National estimates of recovery-remission from serious mental illness. Psychiatr Serv 69(5):523–528.  https://doi.org/10.1176/appi.ps.201700401 CrossRefGoogle Scholar
  28. 28.
    Schneider F, Erhart M, Hewer W, Loeffler LAK, Jacobi F Mortality and somatic comorbidity among people with borderline personality disorder, psychotic disorders, bipolar disorder and severe depression: A comprehensive registry study in Germany. Zur Publikation eingereichtGoogle Scholar
  29. 29.
    Schweiger JU, Schweiger U, Hüppe M, Kahl KG, Greggersen W, Fassbinder (2016) Bone density and depressive disorder: a meta-analysis. Brain Behav 6(8):e489.  https://doi.org/10.1002/brb3.489 CrossRefGoogle Scholar
  30. 30.
    Senaratna CV, English DR, Currier D, Perret JL, Lowe A, Lodge C, Russell M, Sahabandu S, Matheson MC, Hamilton GS, Dharmage SC (2018) Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health. BMC Public Health 16(Suppl 3):1029.  https://doi.org/10.1186/s12889-016-3703-8 Google Scholar
  31. 31.
    Seppala LJ, Wermelink AMAT, de Vries M, Ploegmakers KJ, van de Glind EMM, Daams JG, van der Velde N, EUGMS task and Finish group on fall-risk-increasing drugs (2018) Fall-risk-increasing drugs: a systematic review and meta-analysis: II. psychotropics. J Am Med Dir Assoc 19(4):371.e11–371.e17.  https://doi.org/10.1016/j.jamda.2017.12.098 CrossRefGoogle Scholar
  32. 32.
    Stubbs B, Mueller C, Gaughran F, Lally J, Vancampfort D, Lamb SE, Koyanagi A, Sharma S, Stewart R, Perera G (2018) Predictors of falls and fractures leading to hospitalization in people with schizophrenia spectrum disorder: a large representative cohort study. Schizophr Res.  https://doi.org/10.1016/j.schres.2018.05.010 Google Scholar
  33. 33.
    Stubbs B, Vancampfort D, De Hert M, Mitchell AJ (2015) The prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis. Acta Psychiatr Scand 132(2):144–157CrossRefGoogle Scholar
  34. 34.
    Tanskanen A, Tiihonen J, Taipale H (2018) Mortality in schizophrenia: 30-year nationwide follow-up study. Acta Psychiatr Scand 2018:13.  https://doi.org/10.1111/acps.12913 Google Scholar
  35. 35.
    Toender A, Munk-Olsen T, Vestergaard M, Larsen JT, Suppli NP, Dalton SO, Vedsted P, Nordentoft M, Mortensen PB, Laursen TM (2018) Impact of severe mental illness on cancer stage at diagnosis and subsequent mortality: a population-based register study. Schizophr Res.  https://doi.org/10.1016/j.schres.2018.05.011 Google Scholar
  36. 36.
    Torniainen M, Mittendorfer-Rutz E, Tanskanen A et al (2015) Antipsychotic treatment and mortality in schizophrenia. Schizophr Bull 41(3):656–663CrossRefGoogle Scholar
  37. 37.
    Walker ER, McGee RE, Druss BG (2015) Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 72(4):334–341CrossRefGoogle Scholar
  38. 38.
    Wolter DK (2018) Altgewordene Suchtkranke. Z Gerontol Geriatr.  https://doi.org/10.1007/s00391-018-1440-6 Google Scholar
  39. 39.
    Wu CS, Chang CM, Tsai YT, Huang YW, Tsai HJ (2015) Antipsychotic treatment and the risk of hip fracture in subjects with schizophrenia: a 10-year population-based case-control study. J Clin Psychiatry 76(9):1216–1223.  https://doi.org/10.4088/JCP.14m09098 CrossRefGoogle Scholar
  40. 40.
    Wu CS, Lai MS, Gau SS (2015) Complications and mortality in patients with schizophrenia and diabetes: population-based cohort study. Br J Psychiatry 207(5):450–457.  https://doi.org/10.1192/bjp.bp.113.143925 CrossRefGoogle Scholar
  41. 41.
    Wu H, Deng L, Zhao L, Zhao J, Li L, Chen J (2013) Osteoporosis associated with antipsychotic treatment in schizophrenia. Int J Endocrinol.  https://doi.org/10.1155/2013/167138 Google Scholar
  42. 42.
    Zhuo C, Triplett PT (2018) Association of schizophrenia with the risk of breast cancer incidence: a meta-analysis. JAMA Psychiatry 75(4):363–369.  https://doi.org/10.1001/jamapsychiatry.2017.4748 CrossRefGoogle Scholar
  43. 43.
    Zimmerman M, Morgan TA, Stanton K (2018) The severity of psychiatric disorders. World Psychiatry 17(3):258–275.  https://doi.org/10.1002/wps.20569 CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Geriatrische Klinik, Zentrum für klinische Psychologie und PsychotherapieKath. Marienkrankenhaus gGmbHHamburgDeutschland
  2. 2.Klinik für GerontopsychiatrieKlinikum ChristophsbadGöppingenDeutschland

Personalised recommendations