Abstract
Schizophrenia is a major psychotic disorder with significant comorbidity and mortality. Patients with schizophrenia are said to suffer more type-2 diabetes mellitus (T2DM) and diabetogenic complications. However, there is little consistent evidence that comorbidity with physical diseases leads to excess mortality in schizophrenic patients. Consequently, we investigated whether the burden of physical comorbidity and its relevance on hospital mortality differed between patients with and without schizophrenia in a 12-year follow-up in general hospital admissions. During 1 January 2000 and 31 June 2012, 1418 adult patients with schizophrenia were admitted to three General Manchester NHS Hospitals. All comorbid diseases with a prevalemce ≥1 % were compared with those of 14,180 age- and gender-matched hospital controls. Risk factors, i.e. comorbid diseases that were predictors for general hospital mortality were identified using multivariate logistic regression analyses. Compared with controls, schizophrenic patients had a higher proportion of emergency admissions (69.8 vs. 43.0 %), an extended average length of stay at index hospitalization (8.1 vs. 3.4 days), a higher number of hospital admissions (11.5 vs. 6.3), a shorter length of survival (1895 vs. 2161 days), and a nearly twofold increased mortality rate (18.0 vs. 9.7 %). Schizophrenic patients suffered more depression, T2DM, alcohol abuse, asthma, COPD, and twenty-three more diseases, many of them diabetic-related complications or other environmentally influenced conditions. In contrast, hypertension, cataract, angina, and hyperlipidaemia were less prevalent in the schizophrenia population compared to the control population. In deceased schizophrenic patients, T2DM was the most frequently recorded comorbidity, contributing to 31.4 % of hospital deaths (only 14.4 % of schizophrenic patients with comorbid T2DM survived the study period). Further predictors of general hospital mortality in schizophrenia were found to be alcoholic liver disease (OR = 10.3), parkinsonism (OR = 5.0), T1DM (OR = 3.8), non-specific renal failure (OR = 3.5), ischaemic stroke (OR = 3.3), pneumonia (OR = 3.0), iron-deficiency anaemia (OR = 2.8), COPD (OR = 2.8), and bronchitis (OR = 2.6). There were no significant differences in their impact on hospital mortality compared to control subjects with the same diseases except parkinsonism which was associated with higher mortality in the schizophrenia population compared with the control population. The prevalence of parkinsonism was significantly elevated in the 255 deceased schizophrenic patients (5.5 %) than in those 1,163 surviving the study period (0.8 %, OR = 5.0) and deceased schizophrenic patients had significantly more suffered extrapyramidal symptoms than deceased control subjects (5.5 vs. 1.5 %). Therefore patients with schizophrenia have a higher burden of physical comorbidity that is associated with a worse outcome in a 12-year follow-up of mortality in general hospitals compared with hospital controls. However, schizophrenic patients die of the same physical diseases as their peers without schizophrenia. The most relevant physical risk factors of general hospital mortality are T2DM, COPD and infectious respiratory complications, iron-deficiency anaemia, T1DM, unspecific renal failure, ischaemic stroke, and alcoholic liver disease. Additionally, parkinsonism is a major risk factor for general hospital mortality in schizophrenia. Thus, optimal monitoring and management of acute T2DM and COPD with its infectious respiratory complications, as well as the accurate detection and management of iron-deficiency anaemia, of diabetic-related long-term micro- and macrovascular complications, of alcoholic liver disease, and of extrapyramidal symptoms are of utmost relevance in schizophrenia.
Similar content being viewed by others
References
Ackerblom HK, Vaarala O, Hyoty H et al (2002) Environmental factors in the aetiology of type 1 diabetes. Am J Med Genet 115:18–29
Alberti KG, Zimmer P (2006) The metabolic syndrome: time to reflect. Curr Diab Rep 6(4):259–261
Albrecht JS, Hirshon JM, Goldberg R, Langenbeg P, Day HR, Morgan DJ, Comer AC, Harris AD, Furuno JP (2012) Serious mental illness and acute hospital readmission in diabetic patients. Am J Med Qual 27(6):503–508
Ali S, Stone MA, Peters JL, Davies MJ, Khunti K (2006) The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med 23(11):1165–1173
Almirall J, Gonzales CA, Balanco X, Bolibar I (1999) Proportion of community-acquired pneumonia attributable to tobacco smoking. Chest 116:375–379
American Diabetes Association (2001) Diabetes 2001: vital statistics. ADA, Alexandria
Anderson G, Maes M, Berk M (2012) Schizophrenia is primed for an increased expression of depression through activation of immuno-inflammatory, oxidative and nitrosative stress, and tryptophan catabolite pathways. Prog Neuropsychopharmacol Biol Psychiatry S0278–5846(12):00189-3
Arora NP, Ghali JK (2012) Iron deficiency anaemia in heart failure. Heart Fail Rev. doi:10.1007/s10741-012-9342
Assmann G, Schulte H (1989) European lipid guidelines: therapeutic recommendations. European Atherosclerosis Society. Am J Cardiol 63:53–55
Auquier P, Lançon C, Rouillon F, Lader M, Holmes C (2006) Mortality in schizophrenia. Pharmacoepidemiol Drug Saf 15(12):873–879
Beary M, Hodgson R, Wildgust HJ (2012) A critical review of major mortality risk factors for all cause mortality in first-episode schizophrenia: clinical and research implications. J Psychopharmacol. doi:10.1177/0269881112440512
Beninger RJ, Wasserman J, Zanibbi K, Charbonneau D, Mangels J, Beninger BV (2003) Typical and atypical antipsychotic medications differentially affect two nondeclarative memory tasks in schizophrenic patients: a double dissociation. Schizophr Res 61:281–292
Bertram MY, Vos T (2010) Quantifying the duration of pre-diabetes. Aust N Z J Public Health 34(3):311–314
Bordon J, Wiemken T, Peyrani P, Paz ML, Gnoni M, Cabral P et al (2010) Decrease in long-term survival for hospitalized patients with community-acquired pneumonia. Chest 138:279–283
Bottlender R, Jager M, Groll C, Strauss A, Moeller HJ (2001) Deficit states in schizophrenia and their association with the length of illness and gender. Eur Arch Psychiatry Clin Neurosci 251:272–278
Bottlender R, Strauss A, Moeller HJ (2000) Prevalence and background factors of depression in first admitted schizophrenic patients. Acta Psychiatr Scand 101:153–160
Bresee LC, Majumdar SR, Patten SB, Johnson JA (2010) Prevalence of cardiovascular risk factors and disease in people with schizophrenia: a population-based study. Schizophr Res 117(1):75–82
Brown S, Inskip H, Barraclough B (2000) Causes of the excess mortality of schizophrenia. Br J Psychiatry 177:212–217
Capasso RM, Lineberry TW, Bostwick JM et al (2008) Mortality in schizophrenia and schizoaffective disorder: an Olmsted County, Minnesota cohort: 1950–2005. Schizophr Res 98:287–294
Carney CP, Jones L, Woolson RF (2006) Medical comorbidity in women and men in schizophrenia. A population-based controlled study. J Gen Intern Med 21(11):1133–1137
Carral F, Olveira G, Aguilar M et al (2003) In-hospital discharge records underreport the prevalence of diabetes in hospitals. Diabetes Res Clin Pract 59:145–151
Charlson ME, Pompei P, Ales KL, Mac Kenzie CR (1987) A new method of classifying comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383
Chaves L, Shirakawa I (2008) Nicotine use in patients with schizophrenia evaluated by the Fagerstrom Tolerance Questionnaire: a descriptive analysis from a Brazilian sample. Rev Bras Psyquiatr 30:350–352
Chen YH, Lin HC (2011) Poor clinical outcomes among pneumonia patients with schizophrenia. Schizophr Bull 37:1088–1094
Chen YH, Lee HC, Lin HC (2010) Mortality among psychiatric patients in Taiwan: results from a universal National Health Insurance programme. Psychiatry Res 178:160–165
Chou FH, Tsai KY et al (2013) The incidence and all-cause mortality of pneumonia in patients with schizophrenia: a nine-year follow-up study. J Psychiatr Res 47(4):460–466
Chwastiak L, Rosenheck RA, McEvoy JP, Keefe RS, Swartz MS, Lieberman MD (2006) Interrelationships of psychiatric symptom severity, medical comorbidity, and functioning in Schizophrenia. Psychiatr Serv 57(8):1102–1109, ps.psychiatryonline.org
Cimpean D, Torrey WC, Green AI (2005) Schizophrenia and co-occurring general medical illness. Psychiatr Ann 35(1):71–81
Citrome L, Blonde L, Damatarca C (2005) Metabolic issues in patients with severe mental illness. South Med J 98(7):715–720
Citrome L, Jaffe A, Levine J, Allingham B, Robinson J (2004) Relationship between antipsychotic treatment and new cases of diabetes among psychiatric inpatients. Psychiatr Serv 55:1006–1013
Coclami T, Cross M (2011) Psychiatric comorbidity with type 1 and type 2 diabetes mellitus. East Mediterr Health J 17(10):777–783
Cohen CI, Cohen GD, Blank K, Gaitz C, Katz IR, Leuchter A, Maletta G, Meyers B, Sakauye K, Shamoian C (2000) Schizophrenia and older adults: an overview—directions for research and policy. Am J Geriat Psychiatry 8:19–28
Cooper JE (1994) Pocket guide to the ICD-10 classification of mental and behavioral disorders, with Glossary and Diagnostic Criteria for research. Churchill Livingstone 1994 (Edinburgh, London, Melbourne, New York and Tokyo), in behalf of WHO
Copeland LA, Mortensen EM, Zeber JE, Pugh MJ, Restrepo MI, Dalack GW (2007) Pulmonary disease among inpatients decedents: impact of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 31:720–727
Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ (2012) Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 125:773–781
Cournos F, McKinnon K, Sullivan G (2005) Schizophrenia and comorbid human immunodeficiency virus or hepatitis C virus. J Clin Psychiatry 66(6):27–33
Covey LS, Glassman AH, Stetner F (1990) Depression and depressive symptoms in smoking cessation. Compr Psychiatry 31(4):350–354
Crump C, Winkleby MA, Sundquist K, Sundquist J (2013) Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. Am J Psychiatry 170(3):324–333
Curkendall AM, Jingping M, Glasser DB, Stang MR, Jones JK (2004) Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada. J Clin Psychiatry 65:715–720
Currie CJ, Williams DRR, Peters JR (1996) Pattern’s for in and out patient activity for diabetes: a district survey. Diabetic Med 13:148–153
Daumit GL, Pronovost PJ, Anthony CB, Guallar E, Steinwachs DM, Ford DE (2006) Adverse events during medical and surgical hospitalisations for patients with schizophrenia. Arch Gen Psychiatry 63:267–272
Daumit GL, Anthony CB, Ford DE et al (2010) Pattern of mortality in a sample of Maryland residents with severe mental illness. Psychiatry Res 176:242–245
Davis JM, Barter JT, Kane JM (1989) Antipsychotic drugs. In: Kaplan HI, Sadock BJ (eds) Comprehensive textbook of psychiatry, 5th edn. Williams & Wilkins, Baltimore, pp 1591–1626
De Leon J, Diaz FJ (2005) A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 76(2–3):135–157
De Leon J, Dadvand M, Canuso C, White AO, Stanilla JK, Simpson GM (1995) Schizophrenia and smoking: an epidemiological survey in a state hospital. Am J Psychiatry 152:433–455
Dickstein K, Cohen Solal A et al (2009) ESC Guidelines fort the diagnosis and treatment of acute and chronic heart failure: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Eur Heart J 29(19):2388–2442
Druss BG, Bradford DW, Rosenheck RA, Radford MU, Krumholz HM (2000) Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA 283:506–511
Druss BG, Bradford WD, Roseneck RA, Radford MJ, Krumholz HM (2001) Quality of medical care and access mortality in older patients with mental disorders. Arch Gen Psychiatry 58:565–572
Druss BG, Reisinger-Walker E (2011) Mental disorders and medical comorbidity. Robert Wood Johnson Foundation, Princeton. Retrieved from http://www.rwjf.org/files/research/71883.mentalhealth.report.pdf
Dutt A, McDonald C, Dempster E, Prata D, Shaikh M, Williams I et al (2009) The effect of COMT, BDNF, 5-HTT, NRG1 and DTNBP1 genes on hippocampal and lateral ventricular volume in psychosis. Psychol Med 39(11):1783–1797
Egede LE (2007) Major depression in individuals with chronic medical disorders. Prevalence, correlates and association with health resource utilization. Lost Productivity and functional disability. Gen Hosp Psychiatry 29(5):409–416
El-Mallah P (2006) Evolving self-care in individuals with schizophrenia and diabetes mellitus. Arch Psychiatr Nurs 20:55–64
Fors BM, Isacson D, Bingefors K, Widerlow B (2007) Mortality among persons with schizophrenia in Sweden: an epidemiological study. Nord J Psychiatry 61:252–259
Fusar-Poli P, Borgwardt S, Bechdolf A et al (2012). The psychosis high risk state. A comprehensive state-of-the-art review. Arch Gen Psychiatry. doi:10.1001/jamapsychiatry.2013.269
Glassman AH, Jackson WK, Walsh BT, Roose SP, Rosenfeld B (1984) Cigarette craving, smoking withdrawal, and clonidine. Science 226(4676):864–866
Glassman AH, Stetner F, Walsh BT, Raizman PS, Fleiss JL, Cooper TB, Covey LS (1988) Heavy smokers, smoking cessation, and clonidine. Results of a double-blind, randomized trial. JAMA 259(19):2863–2866
Glassman AH, Covey LS (1990) Future trends in the pharmacological treatment of smoking cessation. Drugs 40(1):1–5
Glassman AH, Helzer JE, Covey LS, Cottler LB, Stetner F, Tipp JE, Johnson J (1990) Smoking, smoking cessation, and major depression. JAMA 264(12):1546–1549
Goldner EM, Hsu L, Waraich P, Somers JM (2002) Prevalence and incidence studies of schizophrenic disorders: a systematic review of the literature. Can J Psychiatry 47:833–843
Green AI, Salomon MS, Brenner MJ, Rawlins K (2002) Treatment of schizophrenia and comorbid substance use disorder. Curr Drug Targest CNS Neurol Disord 1:129–139
George LM, Maddock K (1979) Accuracy of in-hospital activity notifications for infectious diseases. Br Med J 1:1332–1339
Ghali JK (2009) Anaemia and heart failure. Curr Opin Cardiol. doi:10.1097/HCO.0b013e328324ecec
Goff DC, Cather C, Evins AE et al (2005) Medical morbidity and mortality in schizophrenia: guideline for psychiatrist. J Clin Psychiatry 66:183–194
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH (2009) The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. doi:10.1186/1471-2458-9-88
Hafner H, an der Heiden W (1997) Epidemiology of schizophrenia. Can J Psychiatry 42:139–151
Hamer M, Stamatakis E, Steptoe A (2008) Psychiatric hospital admissions, behavioural risk factors, and all cause mortality the Scottish health survey. Arch Intern Med 168:2474–2479
Heun R, Schoepf D, Potluri R, Natalwala A (2013) Alzheimer’s disease and co-morbidity: increased prevalence and possible risk factors of excess mortality in a naturalistic 7-year follow-up. Eur Psychiatry 28(1):40–48
Hill A (1965) The environment and disease: association or causation. Proc R Soc Med 58:295–330
Himmelhoch S, Lehman A, Kreyenbuhl J, Daumit G, Brown C, Dixon L (2004) Prevalence of chronic obstructive pulmonary disease among those with serious mental illness. Am J Psychiatry 161:2317–2319
Hoang U, Stewart R, Goldacre MJ (2011) Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics. BMJ. doi:10.1136/bmj.d5422
Hodgson R, Wildgust HJ, Bushe CJ (2010) Review: cancer and schizophrenia—is there a paradox? J Psychopharmacol 24(4 suppl):51–60. doi:10.1177/1359786810385489
Holt RIG (2004) Diagnosis, epidemiology and pathogenesis of diabetes mellitus: an update for psychiatrists. Br J Psychiatry 184:55–63
Hooley J, Delgado M (2001) Pain insensitivity in the relatives of schizophrenia patients. Schizophr Res 47:265–267
Hor K, Taylor M (2010) Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol 24(4):81–90
International Diabetes Federation (2003) Diabetes Atlas. Retrieved from http://www.idf.org/sites/default/files/IDF_Diabetes_Atlas_2ndEd.pdf
Ito H, Koyama A, Higuchi T (2005) Polypharmacy and excessive dosing: psychiatrist’s perceptions of antipsychotic drug prescription. Br J Psychiatry 187:243–247
Howes O, Ohlson R, Pilowsky LS (2003) Effect of clozapine on mortality. Br J Psychiatry 183:460–461. doi:10.1192/bjp.183.5.460
Jablensky A (1997) The 100-year epidemiology of schizophrenia. Schizophr Res 28:111–125
Jeremias A, Kaul S et al (2009) The impact of revascularisation on mortality in patients with non-acute coronary artery disease. Am J Med 122(2):151–161
Joshy G, Dunn P, Fisher M, Lawrenson R (2009) Ethnic differences in the natural progression of nephropathy among diabetes patients in New Zealand: hospital admission rate for renal complications, and incidence of end-stage renal disease and renal death. Diabetologia 52(8):1474–1478
Joss N, Patel R, Paterson K, Simpson K, Perry C, Stirling C (2007) Anaemia is common and predicts mortality in diabetic nephropathy. QJM 100(10):641–647
Kamalesh M, Cleophas TJ (2009) Heart failure due to systolic dysfunction and mortality in diabetes: pooled analysis of 39,505 subjects. J Card Fail 15(4):305–309
Kelly DL, Mahon RP, Wehring HJ, Liu F et al (2009) Cigarette smoking and mortality risk in people with schizophrenia. Schizophr Bull 37(4):832–838
Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ (1996) The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatry 66(1):17–31
Kilbourne A, Morden N, Austin K, IIgen M, McCarthy J, Dallack G (2009) Excess heart disease-related mortality in a national study of patients with mental disorders: identifying modifiable risk factors. Gen Hosp Psychiatry 31:555–563
Killian JG, Kerr K, Lawrence C, Celermajer DS (1999) Myocarditis and cardiomyopathy associated with clozapine. Lancet 354:1841–1845
Knol MJ, Twisk JW, Beekman AT, Heine RJ, Snoek FJ, Pouwer F (2006) Depression as a risk factor for the onset of type 2 diabetes mellitus: a meta-analysis. Diabetologia 49(5):837–845
Koivula I, Sten M, Makela PH (1999) Prognosis after community-acquired pneumonia in the elderly: a population based 12-year follow-up study. Arch Intern Med 159:1550–1555
Kornum JB, Thomson RW, Riis A et al (2007) Type 2 diabetes and pneumonia outcomes: a population-based cohort study. Diabetes Care 30:2251–2257
Kosborod M, Smith GL, Radford MJ, Foody JM, Krumholz HM (2003) The prognostic importance of anaemia in patients with heart failure. Am J Med 114:112–119
Kreyenbuhl J, Dickerson FB, Medoff DR et al (2006) Extent and management of cardiovascular risk factors in patients with type 2 diabetes mellitus and serious mental illness. J Nerv Ment Dis 194:404–410
Laaksonen MA, Knekt P, Rissanen H, Härkänen T, Virtala E, Marniemi J, Aromaa A, Heliövaara M, Reunanen A (2010) The relative importance of modifiable potential risk factors of type 2 diabetes: a meta-analysis of two cohorts. Eur J Epidemiol 25(2):115–124
Lambert TJR, Velakoulis D, Pantellis C (2003) Medical comorbidity in schizophrenia. Med J Aus 178(9):67–70
Laursen TM (2011) Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophr Res 131:101–104
Laursen TM, Munk-Olsen T, Vestergaard M (2012) Life expectancy and cardiovascular mortality in persons with schizophrenia. Curr Opin Psychiatry 25:83–88
Lee PC, Annapoorna SK, Ahsan C, Fisher E, Sharma SK (2004) Anaemia is an independent predictor of mortality after percutaneous coronary intervention. J Am Coll Cardiol 44:541–546
Leucht S, Burkard T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116:317–333
Lieberman JA, Phillips M, Gu H et al (2003) Atypical and conventional antipsychotic drugs in treatment-naive-first-episode schizophrenia: a 52-week randomized trail of clozapine vs chlorpromazine. Neuropsychopharmacology 28:995–1003. doi:10.1038/sj.npp.1300157
Lin PI, Shuldner AR (2010) Rethinking the genetic basis for comorbidity of schizophrenia and type-2 diabetes. Schizophr Res 123(2–3):234–243
Lindenfeld J (2005) Prevalence of anaemia and effects on mortality with heart failure. Am Heart J 149(3):391–401
Liu Y, Zezhi L, Zhang M, Deng Y, Yi Z, Shi T (2013) Exploring the pathogenetic association between schizophrenia and type-2 diabetes mellitus diseases based on pathway analysis. BMC Medical Genomics 6(Suppl 1):S17. Retrieved from http://www.biomedcentral.com/1755-8794/6/S1/S17
Makikyro T, Karvonen JT, Hakko H et al (1998) Co-morbidity of hospital-treated psychiatric and physical disorders with special reference of schizophrenia: a 28 year follow-up of the 1996 northern Finland general population birth cohort. Public health 112:221–228
Manu P, Kane JM, Corell CU (2011) Sudden deaths in psychiatric patients. J Clin Psychiatry 72(7):936–941
Marder SR (1998) Antipsychotic medications. In: Schatzberg AF, Nemeroff CB (eds) Textbook of psychopharmacology, 2nd edn. American Psychiatric Press, Washington, pp 309–321. doi:10.1176/appi.books.9780890423363.45859
Matsuzaki T, Sasaki K, Tanizaki Y et al (2010) Insulin resistance is associated with the pathology of Alzheimer disease. Neurology 75:764–770
McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ (2005) The relation between hyperglycaemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care 28(4):810–815
McKechnie RS, Smith D, Montoye C, Kline-Rogers E, O’Donnel MJ, DeFranco AC et al (2004) Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Prognostic implication of anaemia on in-hospital outcomes after percutaneous coronary interventions. Circulation 110:271–277. doi:10.1161/01.CIR.0000134964.01697.C7
Meeuwisse-Pasterkamp SH, van der Klauw MM, Wolffenbuttel BH (2008) Type 2 diabetes mellitus: prevention of macrovascular complications. Expert Rev Cardiovasc Ther 6(3):323–341
Meyerhoff DJ, Bode C, Nixon SJ, de Bruin EA, Bode JC, Seitz HK (2005) Health risks of chronic moderate and heavy alcohol consumption: how much is too much? Alcohol Clin Exp Res 29(7):1334–1340
Mezuk B, Eaton WW, Albrecht S, Golden SH (2008) Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 31(12):2383–2390
Miller BJ (2011) Hospital admission for schizophrenia and bipolar disorder: a critical window to recognize and modify the risk of mortality. BMJ 343:D5652
Mitchell AJ, Dinan TJ (2010) Schizophrenia: a multisystem disease. J Psychopharmacol 24(11 (Suppl 4)):5–7
Mortensen EM, Coley CM, Singer DE et al (2002) Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med 162:1059–1064
Mulholland C, Cooper S (2000) The symptom of depression in schizophrenia and its management. Adv Psychiatr Treat 6:169–177. doi:10.1192/apt.6.3.169
Mukherjee S, Decina P, Bocola V, Saraceni F, Scapicchio PL (1996) Diabetes mellitus in schizophrenic patients. Compr Psychiatry 37:68–73
Murphy GM, Lim KO, Wienecke M et al (1998) No neuropathology evidence for an increased frequency of Alzheimer’s disease among elderly schizophrenics. Biol Psychiatry 43:205–209
Moussavi S, Chatterji S et al (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370:851–858
Nanas JN, Matsouka C, Karageorgopoulolos D, Leonti A, Tsolakis E, Drakos SG et al (2006) Aetiology of anaemia in patients with advanced heart failure. J Am Coll Cardiol 48:2485–2489
Newman SC, Bland RC (1991) Mortality in a cohort of patients with schizophrenia: a record linkage study. Can J Psychiatry 36:239–245
Nicholson A, Kuper H, Hemingway H (2006) Depression as an etiologic and prognostic factor in coronary heart disease: a meta-analysis of 6,362 events among 146538 participants in 54 observational studies. Eur Heart J 27(23):2763–2774
Nikolsky E, Mehran R, Aymong E, Mintz GS, Lansky AJ, Lasic Z et al (2004) The impact of anaemia on outcomes of patients undergoing percutaneous coronary intervention. Am J Cardiol 94:1023–1027. doi:10.1161/CIRCINTERVENTIONS.111.965749
Novick D, Haro JM, Bertsch J, Haddad PM (2010) Incidence of extrapyramidal symptoms and tardive dyskinesia in schizophrenia: thirty-six-month results from the European schizophrenia outpatient health outcomes study. J Clin Psychopharmacol 5:531–540
Oertel V, Knöchel C, Rotarska-Jagiela A, Schonmeyer R, Lindner M, van de Ven V, Haenschel C, Uhlhaas P, Maurer K, Linden DE (2010) Reduced laterality as a trait marker of schizophrenia: evidence from structural and functional neuroimaging. J Neurosci 30:2289–2299
Osby U, Correia N, Brandt L et al (2000) Time trends in schizophrenia mortality in Stockholm County, Sweden. BMJ 321:483–484
Parks J, Svendsen D, Singer P, Foti ME (2006) Morbidity and mortality in people with serious mental illness. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, Alexandria. Retrieved from http://www.dsamh.utah.gov/docs/mortality-morbidity_nasmhpd.pdf
Phung TK, Andersen BB, Høgh P, Kessing LV, Mortensen PB, Waldemar G (2007) Validity of dementia diagnoses in the Danish in-hospital registers. Dement Geriat Cogn Disord 24(3):220–228
Prohovnik I, Dwork AJ, Kaufman MA, Wilson N (1993) Alzheimer-type neuropathology in elderly schizophrenia patients. Schizophr Bull 19:805–816
Purcell SM, Wray NR, Stone JL, Visscher PM, O’Donovan MC, Sullivan PF et al (2009) Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature 460(7256):748–752
Rabinowitz T, Frankenburg R, Centorrino F, Kando J (1996) The effect of clozapine on saliva flow rate: a pilot study. Biol Psychiatry 40:1123–1134
Rathore S, Wang Y, Druss B, Masoudi F, Krumholz H (2008) Mental disorders, quality of care, and outcomes in older patients hospitalized with heart failure: an analysis of the national heart failure project. Arch Gen Psychiatry 65:1402–1408
Regier DA, Farmer ME, Rae DS et al (1990) Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. JAMA 264(19):2511–2518
Reinecke H, Trey T, Wellmann J, Heidrich J, Fobker M, Wichter T et al (2003) Haemoglobin-related mortality in patients undergoing percutaneous coronary intervention. Eur Heart J 24:2142–2150
Ritter LM, Meador-Woodruff JH, Dalack GW (2004) Neurocognitive measures of prefrontal cortical dysfunction in schizophrenia. Schizophr Res 68:65–73
Ruigomez A, GarciaRodriguez LA, Dev VJ, Arellano F, Raniwala J (2000) Are schizophrenia or antipsychotic drugs a risk factor for cataracts? Epidemiology 11(6):620–623
Ryan MC, Collins P, Thakore JH (2003) Impaired fasting glucose tolerance in first episode, drug naïve patients with schizophrenia. Am J Psychiatry 160:284–289
Saha S, Chant D, McGrath J (2007) A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry 64:1123–1131
Saddichha S, Manjunatha N, Ameen S, Akhtar S (2008) Diabetes and schizophrenia - effect of disease or drug? Results from a randomized, double-blind, controlled prospective study in first-episode schizophrenia. Acta Psychiatr Scand 117(5):342–347
Saravay S, Pollack S, Steinberg M, Weinschel B, Habert M (1996) Four year follow-up of the influence of psychological comorbidity on medical rehospitalisation. Am J Psychiatry 153:397–403
Satyanarayana S et al (2009) Prevalence and correlates of chronic depression in the Canadian community health survey: mental health and well-being. Can J Psychiatry 54(6):389–398
Schechter MA (2011) Nicotine replacement therapy in the psychiatric emergency department. Am J Psychiatry 168:347–349
Schoepf D, Potluri R, Uppal H, Natalwala A, Heun R (2012) Type-2 diabetes mellitus in schizophrenia: increased prevalence and major risk factor of excess mortality in a naturalistic 7-year follow up. Eur Psychiatry 27(1):33–42
Schoepf D, Heun R, Weiffenbach O, Herrmann S, Maier W (2003) The 4-week prevalence of somatoform disorders and associated psychosocial impairment. Nervenarzt 74(3):245–251
Schuckit MA, Smith TL, Chacko Y (2006) Evaluation of a depression-related model of alcohol problems in 430 probands from the San Diego Prospective Study. Drug Alcohol Depend 82(3):194–203
Seldenrijk A, Vogelzangs N, van Oppen P, Penninx B, van Schaik A (2013) Depression, vascular conditions and chronicity. In: Schoepf D (ed) Psychiatric disorders: new frontiers in affective disorders. InTech, pp 279–294. doi:10.5772/51623
Shurman B, Horan WP, Nuechterlein KH (2005) Schizophrenia patients demonstrate a distinctive pattern of decision-making impairment on the Iowa Gambling Task. Schizophr Res 72:215–224
Singh MK, Giles LL, Nasrallah HA (2006) Pain insensitivity in schizophrenia: trait or state marker? J Psychiatr Pract 12(2):90–102
Sirris SG (2000) Depression in schizophrenia: perspective in the era of atypical antipsychotic agents. Am J Psychiatry 157:1379–1389
Smith M, Hopkins D, Peveler RC, Holt RIG, Woodward M, Ismail K (2008) First vs. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis. Br J Psychiatry 192:406–411
Srinivasan TN, Thara R, Padmavathi R, McCreadie RG (2001) Relationship of extrapyramidal symptoms to age at onset and drug treatment in middle-aged and elderly schizophrenic patients. Schizophr Res 47(1):69–75
Stahl SM (1999) Antipsychotic polypharmacy, part 1. Therapeutic option or dirty little secret. J Clin Psychiatr 60:425–426
Stahl SM, Grady SM (2004) A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation. Curr Med Chem 11:313–327. doi:10.2174/0929867043456070
Steiner J, Walter MD et al (2013) Increased prevalence of diverse N-Methyl-D-Aspartate Glutamate receptor antibodies in patients with an initial diagnosis of schizophrenia. Specific relevance of IgG NR1a antibodies for distinction from N-Methyl-D-Aspartate Glutamate receptor encephalitis. JAMA. Psychiatry 70(3):271–278
Stirban AO, Tschoepe D (2008) Cardiovascular complications in diabetes: targets and interventions. Diabetes Care 31(2):215–221. doi:10.2337/dc08-s257
Suvisaari J, Partti K, Perälä J, Viertiö S, Saarni SE, Lönnqvist J, Saarni SI, Härkänen T (2013) Mortality and its determinants in people with psychotic disorder. Psychosom Med 75(1):60–67
Taylor DC (2003) Schizophrenia and epilepsies: Why? When? How? Epilepsy Behav 4:474–482
Tiihonen J, Lonnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A et al (2009) 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 274:620–627. doi:10.1016/S0140-6736(09)60742-X
Trivedi MH, Corey-Lisle PK et al (2009) Remission, response without remission, and nonresponse in major depressive disorder: impact on functioning. Int Clin Psychopharmcol 24(3):133–138
Ubink-Veltmaat LJ, Bilo HJ, Groenier KH et al (2003) Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in the Netherlands (ZODIAC-1). Eur J Epidemiol 18(8):793–800
Varma A, Appleton DL et al (2010) Iron deficiency anaemia and cardiac mortality in patients with left ventricular systolic dysfunction undergoing coronary stenting. Minerva Cardiolangiol 58:1–10
Wahlbeck K, Mäkinen M (2008). Prevention of depression and suicide. Consensus paper. European Communities, Luxembourg. http://ec.europa.eu/health/archive/ph_determinants/life_style/mental/docs/consensus_depression_en.pdf
Weber NS, Cowan DN, Millikan AM, Niebuhr DW (2009) Psychiatric and general medical conditions co-morbid with schizophrenia in the national hospital discharge survey. Psychiatr Serv 60:1059–1067
Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053
Will JC, Vinicor F, Stevenson J (2001) Recording of diabetes on death certificates. Has it improved? J Clin Epidemiol 54:239–244
Wilder KE, Weinberger DR, Goldberg TE (1998) Operant conditioning and the orbitofrontal cortex in schizophrenic patients: unexpected evidence for intact functioning. Schizophr Res 30:169–174
World Health Organisation (1999) Definition, diagnosis and classification of diabetes mellitus and its complications: Part 1. Diagnosis and classification of diabetes mellitus. World Health Organisation. http://www.aacc.org/sitecollectiondocuments/nacb/lmpg/diabetes/1107_diabetesupdate_draftguidelines.pdf
Wu JH, Dickson M, Durkin M, Canuso CM (2007) Treated liver disease in Medicaid recipients with schizophrenia or bipolar disorder. Primary Psychiatry 14 (10):71–79. http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=1282
Young JK, Forster DA (2000) Cardiovascular procedures in mental disorders. JAMA 283(24):3198–3199. doi:10.1001/jama.283.24.3198
Ziedonis DM, George TP (1997) Schizophrenia and nicotine use: report of a pilot smoking cessation program and review of neurobiological and clinical issues. Schizophr Bull 23(2):247–253
Conflict of interest
The authors have no conflicts of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schoepf, D., Uppal, H., Potluri, R. et al. Physical comorbidity and its relevance on mortality in schizophrenia: a naturalistic 12-year follow-up in general hospital admissions. Eur Arch Psychiatry Clin Neurosci 264, 3–28 (2014). https://doi.org/10.1007/s00406-013-0436-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-013-0436-x