Death Effects and Schizophrenia Drugs

MEDLINE Abstract

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11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study).
Lancet. 2009; 374(9690):620-7 (ISSN: 1474-547X)
Tiihonen J ; Lönnqvist J ; Wahlbeck K ; Klaukka T ; Niskanen L ; Tanskanen A ; Haukka J
Department of Forensic Psychiatry, University of Kuopio and Niuvanniemi Hospital, Department of Clinical Physiology, Kuopio University Hospital, Kuopio, Finland. jari.tiihonen@niuva.fi

BACKGROUND: The introduction of second-generation antipsychotic drugs during the 1990s is widely believed to have adversely affected mortality of patients with schizophrenia. Our aim was to establish the long-term contribution of antipsychotic drugs to mortality in such patients. METHODS: Nationwide registers in Finland were used to compare the cause-specific mortality in 66 881 patients versus the total population (5.2 million) between 1996, and 2006, and to link these data with the use of antipsychotic drugs. We measured the all-cause mortality of patients with schizophrenia in outpatient care during current and cumulative exposure to any antipsychotic drug versus no use of these drugs, and exposure to the six most frequently used antipsychotic drugs compared with perphenazine use. FINDINGS: Although the proportional use of second-generation antipsychotic drugs rose from 13% to 64% during follow-up, the gap in life expectancy between patients with schizophrenia and the general population did not widen between 1996 (25 years), and 2006 (22.5 years). Compared with current use of perphenazine, the highest risk for overall mortality was recorded for quetiapine (adjusted hazard ratio [HR] 1.41, 95% CI 1.09-1.82), and the lowest risk for clozapine (0.74, 0.60-0.91; p=0.0045 for the difference between clozapine vs perphenazine, and p<0.0001 for all other antipsychotic drugs). Long-term cumulative exposure (7-11 years) to any antipsychotic treatment was associated with lower mortality than was no drug use (0.81, 0.77-0.84). In patients with one or more filled prescription for an antipsychotic drug, an inverse relation between mortality and duration of cumulative use was noted (HR for trend per exposure year 0.991; 0.985-0.997). INTERPRETATION: Long-term treatment with antipsychotic drugs is associated with lower mortality compared with no antipsychotic use. Second-generation drugs are a highly heterogeneous group, and clozapine seems to be associated with a substantially lower mortality than any other antipsychotics. Restrictions on the use of clozapine should be reassessed. FUNDING: Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland).

PreMedline Identifier:19595447

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

Another No Suprise News Piece: Doctors too lazy to properly diagnose

HealthierTalk is a website that publishes some of the articles I write that are not posted on Natural Health News.  This note is from their editor and it is certainly worth sharing with NHN readers.

To me, it is certainly no surprise because I hear this from so many people and see it with my clients. It is one of the key reasons when over a decade ago we created our sleuthing service.

Read related article

As we are moving into unchartered territory under health insurance reform, it is best to be well advised, and aware!

What would you say if I told you that your doctor was going to put you on heavy-duty anti-depressants...but not because you are depressed...simple because he was just too lazy to read? It sounds crazy right? Unfortunately--as a new study about to be published in the Journal of Clinical Psychiatry reveals--it's quite common.

Turns out that an astounding 75% of general practice docs...and an additional 25% of psychiatrists...are choosing to ignore their own guidelines when diagnosing major depressive disorder (MDD).

Those guidelines, set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), exist to give doctors the guidance they need and to protect us from being misdiagnosed and improperly treated. But, of course, they only can work if doctors follow them.

When a group of doctors were asked how often they are using the DSM-IV when diagnosing depression, the majority of them answered the multiple-choice question with "less than half of the time."

The author of the study, psychiatrist Dr. Mark Zimmerman, offered up the whiz-bang theory that doctors may not be using the DSM-IV criteria because it's very long and some may not be able to recall all of it.

Umm...excuse me?! He's got to be kidding. The results of the study would have been ridiculous enough on their own. But Dr. Zimmerman's observations send this one right past ridiculous straight to shocking.

Let's see if I can break this one down:

1. The criteria for diagnosing a person with a serious illness are just too long for doctors to recall.
2. And apparently it is too much trouble for them to actually pull them out and read through them when they can't remember them.
3. So, instead, my doctor embracing his laziness, chooses to throw caution to the wind, ignore the guidelines, and pronounces me "seriously depressed."
4. Out comes the prescription pad and, next thing I know, I am doped up on some serious medication(s) to treat my illness. Only problem is, I wasn't even depressed to begin with.

Zimmerman went on to helpfully suggest that perhaps we should shorten up the definition of MDD to assist the docs...who are blatantly ignoring the guidelines...to get their diagnoses right.

I suppose just expecting doctors to do their job would be too much to ask?

If you'd like to see what's in the DSM-IV you can take a look at it here. Better yet, you might want to be sure your doctor has the link.