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Chene M, Sánchez-Rico M, Blanco C, De Raykeer RP, Hanon C, Vandel P, Limosin F, Hoertel N. Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2022; 273:627-638. [PMID: 35723739 DOI: 10.1007/s00406-022-01426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.
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Affiliation(s)
- Margaux Chene
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France. .,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Madrid, Spain
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Pierre Vandel
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Nicolas Hoertel
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Chen WY, Huang SJ, Chang CK, Pan CH, Su SS, Yang TW, Kuo CJ. Excess mortality and risk factors for mortality among patients with severe mental disorders receiving home care case management. Nord J Psychiatry 2021; 75:109-117. [PMID: 32749171 DOI: 10.1080/08039488.2020.1799431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM Home care case management (CM) is the main intervention for patients with severe mental disorders (SMDs) requiring outreach care. This study investigated the long-term mortality outcome and associated risk factors in patients who received home care CM. METHODS This nationwide study enrolled patients who received home care CM (n = 10,255) between 1 January 1999 and 31 December 2010. Each patient was followed up from the baseline (when patients underwent home case CM for the first time during the study period) to the censor (i.e. mortality or the end of the study). We calculated the standardized mortality ratio (SMR) and presented by age and diagnosis. Multivariate regression was performed to assess independent risk factors for mortality. RESULTS Among 10,255 patients who received home care CM, 1409 died during the study period; the overall SMR was 3.13. Specifically, patients with organic mental disorder had the highest SMR (4.98), followed by those with schizophrenia (3.89), major depression (2.98), and bipolar disorder (1.97). In the multivariate analysis, patients with organic mental disorder or dementia had the highest risk, whereas the mortality risk in patients with schizophrenia was comparable to that in patients with bipolar disorder or major depression. Deceased patients had a significantly higher proportion of acute or chronic physical illnesses, including cancer, chronic hepatic disease, pneumonia, diabetes mellitus, cardiovascular disease, and asthma. CONCLUSION This study presented the gap of mortality in patients with SMDs receiving home care CM in Taiwan. We highlight the need for effective strategies to improve medical care for this specified population.
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Affiliation(s)
- Wen-Yin Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taipei, Taiwan
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Kuo Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taipei, Taiwan.,University of Taipei, Taipei, Taiwan.,Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), UK.,Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Sheng-Shiang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Tien-Wei Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Zupanic E, von Euler M, Winblad B, Xu H, Secnik J, Kramberger MG, Religa D, Norrving B, Garcia-Ptacek S. Mortality After Ischemic Stroke in Patients with Alzheimer's Disease Dementia and Other Dementia Disorders. J Alzheimers Dis 2021; 81:1253-1261. [PMID: 33935077 PMCID: PMC8293632 DOI: 10.3233/jad-201459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke and dementia are interrelated diseases and risk for both increases with age. Even though stroke incidence and age-standardized death rates have decreased due to prevention of stroke risk factors, increased utilization of reperfusion therapies, and other changes in healthcare, the absolute numbers are increasing due to population growth and aging. OBJECTIVE To analyze predictors of death after stroke in patients with dementia and investigate possible time and treatment trends. METHODS A national longitudinal cohort study 2007-2017 using Swedish national registries. We compared 12,629 ischemic stroke events in patients with dementia with matched 57,954 stroke events in non-dementia controls in different aspects of patient care and mortality. Relationship between dementia status and dementia type (Alzheimer's disease and mixed dementia, vascular dementia, other dementias) and death was analyzed using Cox regressions. RESULTS Differences in receiving intravenous thrombolysis between patients with and without dementia disappeared after the year 2015 (administered to 11.1% dementia versus 12.3% non-dementia patients, p = 0.117). One year after stroke, nearly 50% dementia and 30% non-dementia patients had died. After adjustment for demographics, mobility, nursing home placement, and comorbidity index, dementia was an independent predictor of death compared with non-dementia patients (HR 1.26 [1.23-1.29]). CONCLUSION Dementia before ischemic stroke is an independent predictor of death. Over time, early and delayed mortality in patients with dementia remained increased, regardless of dementia type. Patients with≤80 years with prior Alzheimer's disease or mixed dementia had higher mortality rates after stroke compared to patients with prior vascular dementia.
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Affiliation(s)
- Eva Zupanic
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mia von Euler
- Department of Neurology and Rehabilitation Medicine, Örebro University Hospital, Örebro, Sweden
- School of Medicine, Örebro University, Örebro, Sweden
| | - Bengt Winblad
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Juraj Secnik
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Milica Gregoric Kramberger
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dorota Religa
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Bo Norrving
- Neurology Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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Sampaio ALP, Caetano D. Mortalidade em pacientes psiquiátricos: revisão bibliográfica. JORNAL BRASILEIRO DE PSIQUIATRIA 2006. [DOI: 10.1590/s0047-20852006000300009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar as informações referentes às taxas de mortalidade em pacientes psiquiátricos publicadas na literatura científica. MÉTODOS: Nesta revisão bibliográfica (bases de dados, sites e periódicos especializados) foram selecionados estudos descritivos e interpretativos que avaliaram as seguintes dimensões: caracterização sociodemográfica, co-morbidades clínicas, tempo de tratamento e diagnósticos relacionados à mortalidade psiquiátrica. As bases de dados avaliadas foram Medline, SciELO e LILACS. RESULTADOS: Os estudos selecionados sobre o tema sugerem que indivíduos com transtornos mentais maiores têm menor tempo de sobrevida em relação à população geral, e há diferenças significativas de mortalidade entre pacientes institucionalizados e aqueles que freqüentam serviços extra-hospitalares. A política de desinstitucionalização do paciente psiquiátrico, que se iniciou no último século, tem causado redução dos leitos psiquiátricos em todos os países; seus efeitos para a saúde geral dos doentes mentais ainda não estão muito claros e necessitam de mais investigações. CONCLUSÃO: É necessária a implantação de intervenções preventivas e terapêuticas que visem à saúde geral dos pacientes psiquiátricos em todos os níveis de assistência de saúde mental.
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Abstract
BACKGROUND The aim was to document the mortality of psychiatric patients within a service system characterised by a low beds-to-population ratio. METHOD All patients admitted to one psychiatric hospital were followed from date of first admission after 31 July 1980 until 31 December 1992 with regard to death, by linkage to the Norwegian Central Register of Persons. Age-adjusted total mortality rates and standardised mortality ratios (SMRs) compared with the general population were computed. RESULTS Mortality rates were highest in men, and increased with age in both sexes. SMRs were highest in the younger age-groups, and the overall SMR was significantly higher for men than for women. Mortality was highest during the first year after admission for both sexes and was higher than in the general population in all diagnostic groups. CONCLUSIONS The mortality of psychiatric patients is still unsatisfactorily high, and men constitute a special high-risk group.
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Affiliation(s)
- V Hansen
- Institute of Community Medicine, University of Tromsø, Norway
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Rössler W, Salize HJ, Riecher-Rössler A. Changing patterns of mental health care in Germany. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 1996; 19:391-411. [PMID: 8968818 DOI: 10.1016/s0160-2527(96)80009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- W Rössler
- Mental Health Services Research Unit, Mannheim, Germany
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