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  1. Popular in: Schizophrenia
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  4. Physical Illness and Schizophrenia: A Review of the Evidence
  5. Physical illness and schizophrenia: a review of the literature. - PubMed - NCBI

Popular in: Schizophrenia

Josefien Breedvelt and Peter Coventry explore a new systematic review and meta-analysis of self-management interventions for people with severe mental illness. Sameer Jauhar and colleagues critically assess the evidence for Open Dialogue, presented in a recent narrative review of quantitative and qualitative studies, which finds that most current studies are highly biased and of low quality, and there is an absence of clear data on effectiveness.

Older Entries. Free trial Close. A further study reported increased frequencies of choking deaths in schizophrenia that may be related to tardive dyskinesia, tachyphagia, and abnormal swallowing Mason and Winton found that the middle ear disease was significantly more common in people with schizophrenia than in other people with psychiatric illness. The hypothesis was that predisposed individuals with hearing impairment may misperceive auditory stimuli and may therefore develop inappropriate associations.

Current status of Electroconvulsive Therapy for mood disorders

In a link of medical examinations of these conscripts with a Swedish National Register of psychosis care, the proportion of schizophrenia among those with severe hearing loss was significantly higher by a factor of 1. Of note is the well established finding that people with schizophrenia, who have never been treated with antipsychotic drugs, often show motor symptoms , There is a quite extensive literature on reduced pain sensitivity in people with schizophrenia, which had already been described by Kraepelin , The data are convincing , although two reviews pointed out that pain perception is altered rather than reduced in schizophrenia , This finding is very important, because it may explain in part the excess rates of physical illness in people with schizophrenia: due to decreased or altered pain perception, people with schizophrenia may fail to seek the help of a doctor.

A number of studies examined the association between schizophrenia and myasthenia gravis , metachromatic leukodystrophy and homocystinuria , , but none of these studies are, by any measure, conclusive. Even less so are two studies that reported a similar geographical distribution pattern of multiple sclerosis and schizophrenia , Given the high frequency of obesity in people with schizophrenia, the study by Winkelman is important because it found high a prevalence of obstructive sleep apnea, for which the most important risk factor is obesity.

With the exception of reports on ocular side effects [e. There are also a number of relatively large studies that showed sexual dysfunction to be more frequent in people with schizophrenia compared to normal controls - Increased prevalence of incontinence in people with schizophrenia have also been reported , One explanation may be the antiproliferative activity of some antipsychotics Pregnancies and births of mothers with schizophrenia are often linked with a variety of psychological, social and behavioural problems.

The situation may be aggravated by high rates of smoking, the use of illicit drugs and alcohol and the intake of antipsychotic medication. Mortality studies have shown consistently that people with schizophrenia die more frequently from cardiovascular diseases and experience sudden death than control populations 6 , , The high rates of smoking , obesity , diabetes , dyslipidemia , lack of exercise often seen in schizophrenia as well as cardiac side effects of antipsychotic drugs probably account for this excessive comorbidity. It is probably also on account of lesser care that people with schizophrenia receive when physically ill.

An Australian study, for example, found that people with schizophrenia receive revascularization procedures much more rarely than the general population 9. Hatta and colleagues examined patients with schizophrenia on emergency admission and found dehydration in 6.

They emphasized the importance of laboratory screenings of patients admitted with acute schizophrenia.

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Another, as yet unexplained, finding is the reduced occurrence of rheumatoid arthritis in people with schizophrenia, first reported as early as by Nissen and Spencer Numerous studies including several tens of thousands of patients were identified 7 , 18 , 85 , - , the vast majority of which found a decreased frequency of rheumatoid arthritis among people with schizophrenia. Nevertheless there are also possible confounders. Some of the earlier studies did not control for age, gender and antipsychotic medication or did not use appropriate diagnostic criteria for the two diseases.

The simplest bias may be underreporting of rheumatoid arthritis by patients with schizophrenia. However, osteoarthritis and unspecific back pain were also decreased, although the latter are not known to be associated with genetic factors. The reduced rates of rheumatoid arthritis may thus also be due to a tendency of people with schizophrenia not to report pain see above.

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There are also many truly epidemiological studies comparing people with schizophrenia and healthy controls 39 , , , , , , - , - , - Most of these studies focused on diabetes; overweight was often used as a secondary measure, whereas only a few studies assessed metabolic syndrome. There are a few studies of patients who did not receive antipsychotic medications, suggesting that schizophrenia itself is associated with altered glucose metabolism, but these studies were too small to be anything but hypothesis generating , Other more plausible reasons for increased obesity and diabetes in patients with schizophrenia are lifestyle factors [self neglect, smoking, negative symptoms, lack of exercise, poor diet , ] that should be considered in addition to exploring the weight inducing effects of some antipsychotics We also found 14 studies that reported high rates of polydipsia in schizophrenia - Chronic water intoxication can also lead to physical complications such as osteoporosis and dilatation of urinary tracts, but cases of cardiac failure, hypertension, and malnutrition have also been reported What is less clear is how often it leads to clinically significant consequences.

In addition to papers on diabetes mentioned above, we found reports on studies on thyroid abnormalities in schizophrenia.

There is a large spectrum of thyroid function test abnormalities in schizophrenia and in psychiatric patients in general - , although these abnormalities seem to be transient and cases of clinically manifest thyroid disease are rare. Neither the reasons for this association nor its clinical relevance are clear. However, since both hypothyroidism and hyperthyroidism can cause a number of psychiatric symptoms, a screening test for thyroid function at admission should be part of any baseline work on newly admitted patients.

Some relevant reports were reviewed in more specific sections above. This review shows that there are a number of physical diseases the incidences of which are more frequent in people with schizophrenia than in the normal population. While some areas have been studied extensively e. In spite of the significant amount of research that has been done, neither the health systems nor individual physicians have undertaken consistent measures to deal adequately with these problems in people with schizophrenia and other mental disorders.

In developing countries the problem may be even more dramatic. The issue of which of the physical diseases contribute most to excess mortality can also vary between countries. According to Harris and Barrowclough 4 the highest standardized mortality rates in schizophrenia were found for infectious diseases followed by respiratory diseases, diabetes and cardiovascular disease. In some countries, excessive number of deaths may indeed be due to infectious diseases, but in the industrialized world, the leading cause of death in the general population is cardiovascular disease.

Therefore, although the standardized mortality rate of cardiovascular disease is not the highest one, the largest single cause of death in schizophrenia in the latter countries could also be cardiovascular disease Distribution of origin of the epidemiological studies summarized in the review.

Only original studies are listed, review articles were excluded. Each country contributed the following numbers of studies. This review has limitations.

This was necessary because there are so many different physical diseases that we might easily have missed, by looking at individual diseases rather than at broad disease categories. Although, in theory, all studies should have been covered by this strategy, this was not necessarily the case because it is possible that the MeSH coding of the papers was imperfect.

It is also clear that due to the broad approach we could not pay attention to detail in specific areas. Some studies looked at serious mental diseases overall rather than specifically at schizophrenia and may have been missed by our search. On the other hand, our search strategy based on MeSH terms included studies that did not use standardized criteria to diagnose schizophrenia. Another limitation is that due to the heterogeneity of the quality and methods applied in the different areas, we found it impossible to apply the same inclusion criteria for each category.

In other areas only a few studies were available, and we included them despite methodological imperfections, also in order to highlight the need for further studies.

Physical Illness and Schizophrenia: A Review of the Evidence

For example, we did not analyze the adverse event data in antipsychotic drug trials. Nevertheless, to the best of our knowledge, a similarly comprehensive review has to date not been undertaken.

We hope that it will serve as a basis for initiatives that will forthcome to fight the high rates of comorbidity in schizophrenia. One class of these is related to the changes in the behaviour of people with schizophrenia. Many of them, preoccupied by their psychotic symptoms, may fail to seek treatment as a consequence.

People with schizophrenia are often isolated and frequently fail to adhere to the recommendations of their doctors concerning treatment and it can be assumed that they also have problems in maintaining their treatment regimes for physical illnesses Patients with schizophrenia have a lifestyle which in itself is an important risk factor for a variety of physical illnesses. Although it has been claimed for a very long time that patients with schizophrenia do not exercise much and have poor diets, only recent evidence has substantiated this claim , Excess mortality is of course true world wide as well.

They set out to tell us what we know about physical illness as it relates to schizophrenia with the expressed purpose of encouraging recognition and intervention earlier in the course of physical illness. Many individuals with schizophrenia receive very limited medical care, and when they do receive care it is often at a point when physical illness is severe or even life threatening.

The authors have done an exhaustive Medline search from to May to look at epidemiological studies of the association between schizophrenia and physical illness. They have specifically avoided including mortality studies and studies that focus primarily on the side effects of medications. Some information is grouped by types of illness, such as infectious disease, cancer, hereditary and neonatal diseases, nutritional and metabolic diseases, and immunologic disorders.

The rest of the information is organized anatomically, including diseases of the nervous system, urogenital disorders, gynecologic and pregnancy-related disorders, and cardiovascular disease. This is followed by a brief discussion of how they determined which articles to include. Some topics have only a few noteworthy studies that the authors summarize. Other areas, such as HIV infection, cancer, complications of pregnancy, cardiovascular disease, metabolic illness, polydypsia, thyroid disease, and rheumatoid arthritis, have an extensive database.

Physical illness and schizophrenia: a review of the literature. - PubMed - NCBI

Detailed tables assist the reader in reviewing theses studies chronologically. Tables include location, research questions, the study and control populations, main findings, data source, and conclusions. Tables do not include how the diagnosis of schizophrenia was made in the study populations, and some studies include other psychiatric diagnostic groups. Forty percent of the studies used come from the United States; the rest are from Europe and elsewhere.

This book will be particularly useful for those doing research on co-occurring medical illness and those researching schizophrenia both in psychiatry and in general medicine.