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BMJ Open. 2012; 2(5): e001810.
Published online Oct 9, 2012. doi:  10.1136/bmjopen-2012-001810
PMCID: PMC3488735
Mortality in schizophrenia and related psychoses: data from two cohorts, 1875–1924 and 1994–2010
David Healy,1 Joanna Le Noury,1 Margaret Harris,1 Mohammed Butt,1 Stefanie Linden,2 Chris Whitaker,3 Lu Zou,3 and Anthony P Roberts1
1North Wales Department of Psychological Medicine, Hergest Unit, Bangor, Wales, UK
2Institute of Psychiatry, King's College London, London, UK
3NWORTH, Bangor University, Bangor, UK
Correspondence to Professor David Healy; david.healy54/at/googlemail.com
Received July 12, 2012; Accepted September 6, 2012.
Abstract
Objective
To investigate death rates in schizophrenia and related psychoses.
Design
Data from two epidemiologically complete cohorts of patients presenting for the first time to mental health services in North Wales for whom there are at least 1, and up to 10-year follow-up data have been used to calculate survival rates and standardised death rates for schizophrenia and related psychoses.
Setting
The North Wales Asylum Denbigh (archived patient case notes) and the North West Wales District General Hospital psychiatric unit.
Population
Cohort 1: The North Wales Asylum Denbigh (archived patient case notes). Of 3168 patients admitted to the North Wales Asylum Denbigh 1875–1924, 1074 had a schizophrenic or related psychosis. Cohort 2: Patients admitted between 1994 and 2010 to the North West Wales District General Hospital psychiatric unit, of whom 355 had first admissions for schizophrenia or related psychoses.
Results
We found a 10-year survival probability of 75% in the historical cohort and a 90% survival probability in the contemporary cohort with a fourfold increase in standardised death rates in schizophrenia and related psychoses in both historical and contemporary periods. Suicide is the commonest cause of death in schizophrenia in the contemporary period (SMR 35), while tuberculosis was the commonest cause historically (SMR 9). In the contemporary data, deaths from cardiovascular causes arise in the elderly and deaths from suicide in the young.
Conclusions
Contemporary death rates in schizophrenia and related psychoses are high but there are particular hazards and windows of risk that enable interventions. The data point to possible interventions in the incident year of treatment that could give patients with schizophrenia a normal life expectancy.
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