Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T07:14:08.862Z Has data issue: false hasContentIssue false
  • English
  • Français

Mortality in schizophrenia

Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study

Published online by Cambridge University Press:  03 January 2018

John L. Waddington ,
Hanafy A. Youssef  and
Anthony Kinsella
John L. Waddington*
Affiliation:
Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin
Hanafy A. Youssef
Affiliation:
St Davnet's Hospital, Monaghan
Anthony Kinsella
Affiliation:
Department of Mathematics, Dublin Institute of Technology, Ireland
*
Professor John L. Waddington, Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland. Fax: 353-1-402 2453; e-mail: jwadding@rcsi.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although increased mortality is one of the most consistent and accepted epidemiological findings in schizophrenia, a high rate of suicide appears unable to account fully for this burden which remains poorly understood.

Method

A cohort of 88 in-patients was followed prospectively over a 10-year period and predictors of survival sought among demographic, clinical and treatment variables.

Results

Over the decade, 39 of the 88 patients (44%) died, with no instances of suicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre-terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival: maximum number of antipsychotics given concurrently (relative risk 2.46, 95% C1 1.10-5.47; P=0.03) and absence of co-treatment with an anticholinergic (relative risk 3.33, 95% C1 0.99-11.11; P=0.05).

Conclusions

Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use of antipsychotic polypharmacy. Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation.

Type
Papers
Information
The British Journal of Psychiatry , Volume 173 , Issue 4 , October 1998 , pp. 325 - 329
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allman, J., McLaughlin, T. & Hakeem, A. (1993) Brain structures and life-span in primate species. Proceedings of the National Academy of Sciences USA, 90, 3559–3563.CrossRefGoogle ScholarPubMed
Barnes, T. R. E. (1990) Comment on the WHO consensus statement, British Journal of Psychiatry, 156, 413–414.Google Scholar
Brown, S. (1997) Excess mortality of schizophrenia. A meta-analysis, British Journal of Psychiatry, 171, 502–508.Google Scholar
Caldwell, C. B. & Gottesman, I. I. (1990) Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin, 16, 571–589.CrossRefGoogle Scholar
Department of Health (1995) Health Statistics 1993. Dublin: Stationery Office. Government of Ireland.Google Scholar
Dufresne, R. L. (1995) Psychiatric pharmacy research workshop: Issues in polypharmacotherapy. Psychopharmacology Bulletin, 31, 789–796.Google Scholar
Jablensky, A. (1995) Schizophrenia: the epidemiological horizon. In Schizophrenia (eds Hirsch, S. R. & Weinberger, D. R.), pp. 206–252. Oxford: Blackwell.Google ScholarPubMed
Joseph, K. S., Blais, L., Ernst, P., et al (1996) Increased morbidity and mortality related to asthma among asthmatic patients who use major tranquillisers. British Medical Journal, 312, 79–83.CrossRefGoogle ScholarPubMed
Kane, J. M. (1995) Psychopharmacological approaches to schizophrenia: practical aspects. In Advances in the Neurobiology of Schizophrenia (eds Den Boer, J. A., Westenberg, H. G. M. & Van Praag, H. M.). pp. 245–263. Chichester: Wiley.Google Scholar
Kane, J. M. (1996) Drug therapy: schizophrenia. New England Journal of Medicine, 334, 34–41.CrossRefGoogle ScholarPubMed
Licht, R. W., Mortensen, P. B., Gouliaev, G., et al (1993) Mortality in Danish psychiatric long-stay patients. 1972–1982. Acta Psychiatrica Scandinavica, 87, 336–341.CrossRefGoogle ScholarPubMed
McKeith, I., Fairbairn, A., Perry, R., et al (1992) Neuroleptic sensitivity in patients with senile dementia of Lewy body type, british Medical Journal, 305, 673–678.Google Scholar
Naftdowitz, D. F., Donovan, S. & Frances, A. (1995) The new polypharmacy in psychiatry: clinical practice and clinical research part company. CNS Drugs, 4, 404–409.CrossRefGoogle Scholar
Rakowski, W. & Mor, V. (1992) The association of physical activity with mortality among older adults in the longitudinal study of aging (1984–1988). Journal of Gerontology, 47, M122–M129.CrossRefGoogle ScholarPubMed
Saku, M., Tokudome, S., Ikeda, M., et al (1995) Mortality in psychiatric patients, with a specific focus on cancer mortality associated with schizophrenia. International Journal of Epidemiology, 24, 366–372.Google Scholar
Stones, M. J., Doman, B. & Kozma, A. (1989) The prediction of mortality in elderly institution residents. Journal of Gerontology, 44, P72–P79.Google Scholar
Waddington, J. L. (1992) Mechanisms of neuroleptic -induced extrapyramidal side effects. In Adverse Effects of Psychotropic Drugs (eds Kane, J. M. & Lieberman, J. A.), pp. 246–265. New York: Guilford Press.Google Scholar
Waddington, J. L. (1993) Schizophrenia: developmental neuroscience and pathobiology. Lancet, 341, 531–536.CrossRefGoogle ScholarPubMed
Waddington, J. L. (1995) The clinical psychopharmacology of antipsychotic drugs in schizophrenia. In Schizophrenia (eds Hirsch, S. R. & Weinberger, D. R.), pp. 341–357. Oxford: Blackwell.Google Scholar
Waddington, J. L., Youssef, H. A., Dolphin, C., et al (1987) Cognitive dysfunction, negative symptoms and tardive dyskinesia in schizophrenia. Archives of General Psychiatry, 44, 907–912.Google Scholar
Waddington, J. L., Youssef, H. A., & Kinsella, A. (1990) Cognitive dysfunction in schizophrenia followed up over five years, and its longitudinal relationship to the emergence of tardive dyskinesia. Psychological Medicine, 20, 835–842.CrossRefGoogle Scholar
Waddington, J. L., Youssef, H. A., & Kinsella, A. (1995) Sequential cross-sectional and 10-year prospective study of severe negative symptoms in relation to duration of initially untreated psychosis in chronic schizophrenia. Psychological Medicine, 25, 849–857.Google Scholar
Weinberger, D. R. (1995) Schizophrenia: from neuropathology to neurodevelopment. Lancet, 346, 552–557.CrossRefGoogle ScholarPubMed
Working Group of the Royal College of Psychiatrists, Psychopharmacology Sub-Group (1997) The Association between Antipsychotic Drugs and Sudden Death. Council Report CR57. London: Royal College of Psychiatrists.Google Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. (ICD-9). Geneva: WHO.Google Scholar
World Health Organization Heads of Centres Collaborating in WHO Coordinated Studies on Biological Aspects of Mental Illness (1990) Prophylactic use of anticholinergics in patients on long-term neuroleptic treatment. A consensus statement, british Journal of Psychiatry, 156, 412.Google Scholar
Yoneyama, T., Hashimoto, K., Fukuda, H., et al (1996) Oral hygiene reduces respiratory infections in elderly bed-bound nursing home patients. Archives of Gerontology and Geriatrics, 22, 11–19.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.