Causes of Mortality in Patients with Schizophrenia

The Nursing Shortage
January 6, 2017
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April 5, 2017

Causes of Mortality in Patients with Schizophrenia

Schizophrenia is a rare illness affecting approximately 1% of the population (Lumby, 2007). Women are usually diagnosed in mid thirties, whereas men in mid twenties (Pack, 2008). According to a study by Roberson (2009), 1% of the affected individuals experience symptoms before the age of 13 and 4% experience symptoms prior to age 18. The cause of this illness is unidentified; however, it is considered to be a combination of human genome and organic factors. Pack (2008) proved that schizophrenia is linked to environmental stressors, such as child abuse, dysfunctional relationships, and social trauma. Family and friends of individuals with schizophrenia notice regressive behavior, impaired communication, and withdrawal from reality (Roberson, 2009). The following is an exploration of the factors that cause mortality in patients diagnosed with schizophrenia. High rates of mortality among these individuals is a result of life style factors, including lack of physical activity, poor diet, family disengagement, employment, and physical illnesses, such as diabetes, cardio vascular disease, respiratory disorder , cancer, and type 2 diabetes. Lastly, poor health care and treatment compliance are major causes of mortality in patients with schizophrenia.

Positive symptoms such as hallucinations, delusions and disorganized thinking are associated with schizophrenia. These symptoms are considered positive because of favorable responses to medication. Negative symptoms do not have encouraging responses to medications. These include impairment of normal traits or abilities, such as blunted effects, emotions, lack of speech, and pleasure. Areas impacted by cognitive impairment include language, memory, and attention. Affective disturbance in people with schizophrenia have inappropriate and odd expressions carried by demoralization and depression (Roberson, 2009).

Individuals with schizophrenia tend to die earlier, compared to the general population, with a life expectancy reduction of 10 years. Major physical illnesses affecting mortality include obesity, type 2 diabetes, and cardio vascular diseases  (Pack, 2008). Reasons for this mortality rate include suicides and accidents; however, 92% of individuals with schizophrenia die from natural causes (Copeland, Zeber, Wang, Parchman, Lawrence, Valenestein, and Miller, 2009).

Studies indicate that 42% of individuals with schizophrenia are obese. Weight gain is observed in newer antipsychotics, such as clozapine and olanzapine compared to the older antipsychotics such as Risperdal and Seroquel which have moderate adverse metabolic effects (Lumby, 2007). One meta analysis estimated that mean weight gain in patients over a 10 week period was 4.45kg with colozapine, 4.15kg with olanzapine, 2.92kg with sertindole, 2.10kg with risperidone, and 0.04kg with ziprasidone (Maj, 2008). Even though weight gain has been observed with atypical antipsychotic drugs, obesity due to poor diet is recognized early in treatment with chlorpromazine and depot injection (Pack, 2008).

Although antipsychotic drugs result in significant weight gain, poor diet and reduced physical activity are contributing factors. Despite the adverse effects of antipsychotics, unhealthy diet, high in lipids and low in fiber are associated with schizophrenia. A study conducted in the United Kingdom by Maj (2008) found obesity is higher among schizophrenic individuals (body mass index higher than 30) and morbid obesity (body mass index higher than 40), compared to the general population. Consumption of unhealthy food, poverty, and unstable living conditions contribute to a higher rate of poor diet.  A study in the United States examined if nutritional education can affect weight gain; 35 people with schizophrenia over a 4 month period were educated on the importance of dietary guidelines. Significant weight loss and better eating habits were observed (Beebe, 2008).

The risk of mortality from diabetes varies depending on sex, age, and severity of illness. People with schizophrenia are more likely to develop type 2 diabetes. Schizophrenia can impair cognitive function, which is essential for self-management of type 2 diabetes. It is suggested that prevalence of diabetes is a result of genetic predisposition of insulin resistance due to poor diet and antipsychotics (Lumby, 2007). Pack (2008) summarizes “insulin resistance results from an interplay between genetic and lifestyle factors” (p. 42). Individuals with this illness have a greater risk of developing complications from type 2 diabetes, compared to the general population (Beebe, 2008).

About 40-45% of all natural deaths in people with schizophrenia are reported between the ages of 45 and 70 years, with primary cause of cardiovascular diseases. Compared to the general population, sudden cardiac death is experienced three times greater in people with schizophrenia (Koponen, Alaraisanen, Saari, Pelkonen, Huikuri, Pekka, Raatikainen, Savolainen, and Isohanni, 2008). Cardiovascular disease is linked to obesity, smoking, and lack of physical activity. Patients present an increased risk of developing a combination of both cardiovascular diseases and type 2 diabetes. This is defined as metabolic syndrome (Pack, 2008).

Over 70% of individuals with schizophrenia smoke more than 20 cigarettes per day. As a result, death from lung cancer is twice that of the general population. Smoking cessation counseling is not commonly offered to this group of people. Researchers believe there may be a biological link between smoking and schizophrenia (Lumby, 2007). Interference of nicotine affects the metabolism of antipsychotic drugs, meaning higher doses for the patient. Psychotic symptoms may worsen due to nicotine withdrawal; therefore, nicotine replacement is a better strategy (Pack, 2008).

High mortality rate is reported because of lower socioeconomic conditions (Lumby, 2007). Greater involvement of family and friends in the lives of individuals with schizophrenia has a tremendous positive impact on the patients’ health. A 9-month study in patients with schizophrenia concluded that support from family and friends predicted regular usage of medication, and symptoms remained stable (Garcia, Chang, Young, Lopez, and Jenkins, 2006).

European health policy restructures the role that families play in assistance of patients with disabilities and unpaid social and economic contributions to health care (Pollio, North, Reid, Miletic, and McClendon, 2006). A study conducted by Chien, Chan, Morrissey, and Thompson (2004) reveals that improvement in patients’ health is the result of support from family and friends. Caring for patients fosters positive patient and family outcomes, particularly with patient relapse and re-hospitalization.

Funding for stabilization services in the community has been cut due to government policies, and families of patients feel overwhelmed. If family and friends of individuals with serious mental illnesses are provided knowledge, support, and social services, patients’ health can improve (Magliano, Fiorillo, DeRosa, and Maj, 2006; Pollio et al., 2006). Lifestyle factors causing mortality in patients with schizophrenia are modifiable. Adequate housing, employment, and community services are essential for individuals with schizophrenia, and their families can improve their quality of life and decrease the rate of mortality.

International studies indicate primary care providers improve quality of health (Garcia et al., 2006). Poor treatment compliance and failure to diagnose mental illnesses are major problems in our health care system, and causes high mortality among schizophrenic patients. People with schizophrenia have decreased access to medical services. There are several factors regarding this concern, including cost of care and medical insurance. An American study found that people with preexisting conditions, especially of mental disorder, were denied medical insurance. Another study in the US found that physical illnesses were not diagnosed approximately 33% in men and 31% in women (Maj, 2008).

A study in the United States found that adverse events during medical hospitalization in people with schizophrenia are more frequent, compared to the general population, due to infections from lack of medical care. These events are linked to higher probability of admission to an intensive care unit (Maj, 2008). A study carried out in the United Kingdom examined that respiratory and cardiovascular symptoms were frequent in patients with schizophrenia, compared to the general population, whereas practitioner attendance rate is lower towards individuals with schizophrenia (Maj, 2008). Researchers examined that practitioners occasionally misinterpret psychotic patients or may be unskilled and feel discomfort diagnosing this population (Lumby, 2007).

Mortality among patients with schizophrenia results from a number of life style factors, such as diet, physical activity, and smoking. Patients need regular comprehensive follow-ups of their physical health. This close follow-up may decrease mortality rate (Koponen et al., 2008). According to Lumby (2007), “All manifestations of metabolic syndrome can be improved through lifestyle modifications that include a high-fiber, low fat diet and exercise” (p. 32). Health care providers should raise awareness on mental health issues and stress upon public policies, such as employment, housing, and the strengthening of community services. Improvement in patients’ health is related to the support from family and friends. Maj (2008) studied that physical healthcare and quality of care are lower among these patients. Caring for mentally ill people and their civil rights are our responsibility as human beings and citizens. Physical health is a crucial dimension of quality of life in these people and the quality of care should be the same as to the rest of the population.

References

Beebe, L. (2008). Obesity in schizophrenia: screening, monitoring and health promotion.                           Perspectives in psychiatric care. Perspectives in Psychiatric Care , Vol. 44.

Chien, W., Chan, S., Morrissey, J., Thompson, D. (2004). Effectiveness of a mutual support                      group for families of patients with schizophrenia. Journel of Advanced Nursing , 595         -608.

Copeland, L., Zeber, J., Wang, C., Parchman, M., Lawrence, V., Valenstein, M., Miller, A.                       (2009). Patterns of primary care and mortality among patients with schizophrenia or                      diabetes: a cluster analysis approach to the retrospective study of health care utilization.                      BMC Health Services Research .

Garcia, J., Chang, C., Young, J., Lopez, S., Jenkins, J. (2006). Family support predicts                               psychiatric medication usage among Mexican American indivuals with schizophrenia.                    Soc Psychiatry Psychiatr Epidemiol , 624-631.

Koponen, H., Alaraisanen, A., Saari, K., Pelkonen, O., Huikuri, H., Raatikainen, M., Savolainen,              M., Isohanni, M. (2008). Schizophrenia and sudden cardiac death- A review. Imforma             Healthcare , 342-345.

Lumby, B. (2007). Guide Schizophrenia patients to better physical health. The Nurse                                 Practitioner , Vol. 23 No. 7.

Magliano, L., Fiorillo, A., DeRosa, C., Maj, M. . (2006). Family burden and social network in                   schizophrenia vs. physical diseases: preliminary results from an Italian national study.                    Acta Psychiatrica Scandinavica , 60-63.

Maj, M. (2008). Physical illness and access to medical services in people with schizophrenia.                     International journal of mental health , 13-21.

Pack, S. (2008). Poor physical health and morality in patients and schizophrenia. Art and Science              Mental Health , 21, 23, 41-45.

Pollio, D., North, C., Reid, D., Miletic, M., McClendon, J. (2006). Living with severe mental                    illness- What families and friends must know: Evaluation of a one-day psychoeducation               workshop. National Association of Social Workers .

Roberson, C. (2009). Schizophrenia. Alabama: The Alabama State Nurse Association.

 

These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: 23.ahmad@gmail.com