OBJECTIVE: Schizophrenia is associated with a shortened life expectancy and increased somatic comorbidity with, e.g., cardiovascular disorders. One major risk factor for these disorders is the metabolic syndrome, which has been reported to have a higher frequency in schizophrenic patients. Our objective was to study the prevalence of metabolic syndrome in a population-based birth cohort. METHOD: The study sample consisted of 5613 members of the Northern Finland 1966 Birth Cohort who participated in the field study from 1997 to 1998. Subjects were divided into 4 diagnostic categories (DSM-III-R): (1) schizophrenia (N = 31), (2) other functional psychoses (N = 22), (3) nonpsychotic disorders (N = 105), and (4) no psychiatric hospital treatment (N = 5455, comparison group). Subjects were assessed for the presence of metabolic syndrome according to the criteria of the National Cholesterol Education Program. RESULTS: The prevalence of metabolic syndrome was higher in subjects with schizophrenia compared with the comparison group (19% vs. 6%, p = .010). The prevalence of metabolic syndrome in subjects with other psychoses was 5%. After controlling for sex, the results of logistic regression analysis showed that the risk of metabolic syndrome in schizophrenia was 3.7 (95% CI = 1.5 to 9.0). CONCLUSIONS: The high prevalence of metabolic syndrome in schizophrenia even at such a relatively young age underscores the need to select antipsychotic medications with no or little capability to induce metabolic side effects. Also, developing comprehensive efforts directed at controlling weight and diet and improving physical activity are needed.
Patients with schizophrenia requiring long-term institutionalization represent those with the worst outcome, leading to personal costs for patients and relatives and constituting a large economical burden for society.
To identify characteristics and predictors of outcome of institutionalized patients with schizophrenia.
One-year follow-up cohort study, utilizing the Danish national registers, of all institutionalized and non-institutionalized patients with schizophrenia in Denmark with an ICD-10 lifetime diagnosis of schizophrenia (F20.0-F20.9) since 1969 and alive at the index date of January 1st 2006 (total number 22,395).
Compared with non-institutionalized patients, institutionalized patients (n=2188; 9.8%) had earlier onset of schizophrenia and lower scholastic achievements, were more often diagnosed with a hebephrenic subtype (odds ratio (OR), 2.34; 95% confidence interval (CI), 1.95-2.80; p
OBJECTIVE: To compare prescribed daily doses (PDDs) of psychotropic drugs in several European centres. METHOD: A one-day census of psychotropic drug prescriptions to 613 patients in 39 acute psychiatric wards in ten countries. RESULTS: Patients in Spain were on most drugs; patients in Germany were on the fewest. Chlorpromazine equivalents in Denmark, England, Germany and Spain were at high levels as were diazepam equivalents in Belgium, Finland, The Netherlands and Norway. Newer anti-psychotics were used in the majority of centres, although older anti-psychotics were used commonly in three centres. CONCLUSION: The high doses of psychotropic drugs patients receive in some centres may be having little additional therapeutic effect and could increase their risk of side effects. The use of older anti-psychotics in some centres may be causing side effects that could be reduced by using newer anti-psychotics.
Oral health status is poor and a disregarded health issue among patients with schizophrenia that is associated with the risk for additional social stigmatization and potentially fatal infections.
A historical, prospective database study of dental visits, utilizing the Danish National Patient Registry, of 21,417 patients with ICD-10-diagnosed schizophrenia in the year 2006 and of 18,892 patients for the 3-year period of 2004-2006 was conducted. Multiple logistic regression analyses were used to identify risk factors for lack of dental care.
Only 43% of patients with schizophrenia (9,263/21,417)--compared to an annual dental visit rate of 68% in the general adult Danish population (2,567,634/3,790,446)-visited the dentist within 12 months in 2006 (OR = 2.8; 95% CI, 2.7-2.9; P 50 years were associated with a lower risk for inappropriate dental care.
Patients with schizophrenia visit dentists much less frequently than the general population in the same country. Health professionals should pay more attention to the dental health care of patients with schizophrenia, actively encourage patients to regularly visit the dentist, and establish a formal collaboration with dentists to improve the dental health aspects of this disadvantaged patient group.
To determine the prevalence rates of hepatitis C in patients with schizophrenia and schizoaffective disorder being treated with clozapine.
Clozapine-treated outpatients and inpatients were recruited from the Centre for Addiction and Mental Health Schizophrenia Program in Toronto, Canada. All subjects had liver function tests, and positive HCV status was defined as a positive qualitative HCV RNA assay. Subjects completed a self-report questionnaire assessing HCV risk factors, past history of liver disease, previous diagnosis of human immunodeficiency virus (HIV), past hepatitis B virus (HBV) infection and current alcohol use.
110 subjects participated in the study and the HCV prevalence rate (antibody and viremia-positive) was 2.7%, compared to a 0.8% prevalence rate in Canada. All study subjects had established housing, none reported a history of HIV, and only one patient had a history of HBV infection. A total of 9% drank two or more drinks on a typical day drinking and 7% endorsed having six or more drinks on one occasion at least monthly. Two of 3HCV-viremia positive subjects had HCV risk factors, specifically intravenous drug use and intranasal cocaine use. There was no difference between HCV infected and HCV negative subjects on liver function tests.
Our study demonstrates elevated rates of HCV in clozapine-treated patients compared to the general population in Canada and are congruent with reports from United States centres. Our study highlights the importance of homelessness and patterns of high-risk behaviour when interpreting HCV prevalence rates in this sub-population of patients and should be explored in future studies.
Identifying patients at risk of poor outcome at an early stage of illness can aid in treatment planning. This study sought to create a best-fit statistical model of known baseline and early-course risk factors to predict time in psychosis during a ten-year follow-up period after a first psychotic episode.
Between 1997 and 2000, 301 patients with DSM-IV nonorganic, nonaffective first-episode psychosis were recruited consecutively from catchment area-based sectors in Norway and Denmark. Specialized mental health personnel evaluated patients at baseline, three months, and one, two, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores =4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses.
Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow-up: deterioration in premorbid social functioning, duration of untreated psychosis (DUP) of =26 weeks, core schizophrenia spectrum disorder, and no remission within three months.
First-episode psychosis patients should be followed carefully after the start of treatment. If symptoms do not remit within three months with adequate treatment, there is a considerable risk of a poor long-term outcome, particularly for patients with a deterioration in premorbid social functioning, a DUP of at least half a year, and a diagnosis within the core schizophrenia spectrum.
Life course studies of schizophrenia that have used a 3-phase model (onset, course, and outcome) have had their use restricted owing to differences in definition and methodology. The purpose of this investigation was to describe life course data in mathematical terms and to compare the results with the findings from other life course studies.
The study population was comprised of 128 of 137 people who were first admitted for schizophrenia to 1 of the 2 mental hospitals in Alberta in 1963 and followed until 1997 or death. Patient evaluations were based on retrospective and contemporaneous information collected from the patients and hospital files, treatment records, and family members. Mathematically derived ratings were formulated for course, outcome, and onset (pre-admission years). The distribution of the resulting 8 life course types was compared with profiles drawn from other such studies reported in the literature.
The use of mathematical descriptions of onset, course, and outcome produced profiles that did not closely match the results of other investigations, largely owing to inconsistency across studies. Further, the present approach to outcome measurement produced results that were less favourable than those found in other studies.
Studies on the life course of schizophrenia could be made more comparable by specifying mathematically expressed operational definitions of onset, course, and outcome. Nonetheless, the use of the term outcome can be questioned as it implies an assessment at a specific time rather than providing a summary statement of the quality of a life.
The results of the study of 158 patients with alcohol dependence, comorbid in 85 cases with slow progressive schizophrenia and in 75 cases with affective disorders (cyclothymia), are viewed in the aspect of a theory of comorbidity. The psychopathological peculiarities of each nosologic form are singled out. The author stresses that establishing of the comorbid pathology is important for the right therapeutic strategy. The effectiveness of using the combinations of neuroleptics, either typical or atypical, and antidepressants (tricyclic, SSRIs etc) is revealed.
BACKGROUND: Because of widely disparate findings from follow-up studies, the likelihood of recovery from schizophrenia remains controversial. We report the extent of recovery from schizophrenia in a population-based cohort. METHOD: Subjects with psychotic disorders were recruited from the Northern Finland 1966 Birth Cohort. Of the 91 subjects who agreed to participate, 59 were diagnosed with schizophrenia and 12 were diagnosed with schizophrenia spectrum disorders (schizophreniform psychosis, schizoaffective or delusional disorder) by DSM-III-R criteria. Diagnoses were established by interviewing the subjects, checking the Finnish Hospital Discharge Register, and reviewing their medical records. To assess recovery, we used the Clinical Global Impressions; the Positive and Negative Syndrome Scale; the Social and Occupational Functioning Assessment Scale; and information about psychiatric hospitalizations, use of antipsychotic medication, and occupational status. RESULTS: Only 1 subject (1.7%) with DSM-III-R schizophrenia and 3 subjects (25%) with schizophrenia spectrum disorders fully recovered; 1 schizophrenia subject (1.7%) and 2 schizophrenia spectrum subjects (16.7%) experienced partial recovery. CONCLUSION: The data indicate that, at least until age 35, complete recovery from schizophrenia is rare, and the prognosis for the disorder is far more serious than suggested by some follow-up studies.