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Transformation of excess mortality in people with schizophrenia and bipolar disorder in Taiwan

Published online by Cambridge University Press:  26 April 2017

Y.-J. Pan*
Affiliation:
Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan National Yang-Ming University School of Medicine, Taipei, Taiwan
L.-L. Yeh
Affiliation:
Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
H.-Y. Chan
Affiliation:
Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
C.-K. Chang
Affiliation:
Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology, and Neuroscience), London, UK
*
*Address for correspondence: Y.-J. Pan, Department of Psychiatry, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan. (Email: panyiju0211@gmail.com)

Abstract

Background

Given the concerns regarding the adverse health outcomes associated with weight gain and metabolic syndrome in relation to use of second-generation antipsychotics (SGAs), we aimed in this study to explore whether the increase in the use of SGAs would have any impacts on the trend of excess mortality in people with schizophrenia and bipolar disorder (BPD).

Method

Two nationwide samples of individuals with schizophrenia and BPD were identified in Taiwan's National Health Insurance Research Database in 2003 and in 2008, respectively. Age- and gender-standardized mortality ratios (SMRs) were calculated for each of the 3-year observation periods. The SMRs were compared between the calendar year cohorts, by disease group, and by causes of death.

Results

The mortality gap for people with schizophrenia decreased slightly, revealing an SMR of 3.40 (95% CI 3.30–3.50) for the 2003 cohort and 3.14 (3.06–3.23) for the 2008 cohort. The mortality gap for BPD individuals remained relatively stable with only those aged 15–44 years having an SMR rising significantly from 7.04 (6.38–7.76) to 9.10 (8.44–9.79). Additionally, in this group of BPD patients aged 15–44 years, the natural-cause-SMR increased from 5.65 (4.93–6.44) to 7.16 (6.46–7.91).

Conclusions

Compared with the general population, the gap in the excess mortality for people with schizophrenia reduced slightly. However, the over 200% difference between the cohorts in the excess mortality for BPD individuals aged 15–44 years could be a warning sign. Future research to further examine the related factors underlying those changes is warranted.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2017 

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References

American Psychiatric Association (2002). Practice guideline for the treatment of patients with bipolar disorder (revision) - Introduction. American Journal of Psychiatry 159, 250.Google Scholar
Alexander, GC, Gallagher, SA, Mascola, A, Moloney, RM, Stafford, RS (2011). Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiology and Drug Safety 20, 177184.Google Scholar
Bardgett, ME, Franks-Henry, JM, Colemire, KR, Juneau, KR, Stevens, RM, Marczinski, CA, Griffith, MS (2013). Adult rats treated with risperidone during development are hyperactive. Experimental and Clinical Psychopharmacology 21, 259267.Google Scholar
Chang, CK, Hayes, RD, Broadbent, M, Fernandes, AC, Lee, W, Hotopf, M, Stewart, R (2010). All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study. BMC Psychiatry 10, 77.Google Scholar
Chen, EY, Tang, JY, Hui, CL, Chiu, CP, Lam, MM, Law, CW, Yew, CW, Wong, GH, Chung, DW, Tso, S, Chan, KP, Yip, KC, Hung, SF, Honer, WG (2011). Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Early Intervention in Psychiatry 5, 315323.Google Scholar
Choi, YK, Moran-Gates, T, Gardner, MP, Tarazi, FI (2010). Effects of repeated risperidone exposure on serotonin receptor subtypes in developing rats. European Neuropsychopharmacology 20, 187194.CrossRefGoogle ScholarPubMed
Correll, CU, Blader, JC (2015). Antipsychotic use in youth without psychosis: a double-edged sword. JAMA Psychiatry 72, 859860.Google Scholar
Correll, CU, Joffe, BI, Rosen, LM, Sullivan, TB, Joffe, RT (2015). Cardiovascular and cerebrovascular risk factors and events associated with second-generation antipsychotic compared to antidepressant use in a non-elderly adult sample: results from a claims-based inception cohort study. World Psychiatry 14, 5663.Google Scholar
Correll, CU, Manu, P, Olshanskiy, V, Napolitano, B, Kane, JM, Malhotra, AK (2009). Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA 302, 17651773.Google Scholar
Dutta, R, Murray, RM, Allardyce, J, Jones, PB, Boydell, JE (2012). Mortality in first-contact psychosis patients in the U.K.: a cohort study. Psychological Medicine 42, 16491661.Google Scholar
Gardner-Sood, P, Lally, J, Smith, S, Atakan, Z, Ismail, K, Greenwood, KE, Keen, A, O'Brien, C, Onagbesan, O, Fung, C, Papanastasiou, E, Eberhard, J, Patel, A, Ohlsen, R, Stahl, D, David, A, Hopkins, D, Murray, RM, Gaughran, F, IMPaCT team (2015). Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial. Psychological Medicine 45, 26192629.Google Scholar
Harris, MG, Burgess, PM, Chant, DC, Pirkis, JE, McGorry, PD (2008). Impact of a specialized early psychosis treatment programme on suicide. Retrospective cohort study. Early Intervention in Psychiatry 2, 1121.Google Scholar
Hayes, RD, Downs, J, Chang, CK, Jackson, RG, Shetty, H, Broadbent, M, Hotopf, M, Stewart, R (2015). The effect of clozapine on premature mortality: an assessment of clinical monitoring and other potential confounders. Schizophrenia Bulletin 41, 644655.Google Scholar
Hennekens, CH, Hennekens, AR, Hollar, D, Casey, DE (2005). Schizophrenia and increased risks of cardiovascular disease. American Heart Journal 150, 11151121.Google Scholar
Higham, J, Flowers, J, Hall, P (2005). Standardisation. Eastern Region Public Health Observatory: Cambridge. Issue 6 (http://www.scotpho.org.uk/downloads/methodology/INPHORM%206-FINAL.pdf).Google Scholar
Hoang, U, Stewart, R, Goldacre, MJ (2011). Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006. BMJ 343, d5422.Google Scholar
Lahti, M, Tiihonen, J, Wildgust, H, Beary, M, Hodgson, R, Kajantie, E, Osmond, C, Raikkonen, K, Eriksson, J (2012). Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia. Psychological Medicine 42, 22752285.Google Scholar
Lakka, HM, Laaksonen, DE, Lakka, TA, Niskanen, LK, Kumpusalo, E, Tuomilehto, J, Salonen, JT (2002). The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288, 27092716.Google Scholar
Laursen, TM, Mortensen, PB, MacCabe, JH, Cohen, D, Gasse, C (2014). Cardiovascular drug use and mortality in patients with schizophrenia or bipolar disorder: a Danish population-based study. Psychological Medicine 44, 16251637.Google Scholar
Lee, T, Yang, C, Wang, T (2011). Population ageing and national health insurance expenditures: a time-to-death analysis. (in Chinese). Journal of Population Studies 43, 135.Google Scholar
Maher, AR, Maglione, M, Bagley, S, Suttorp, M, Hu, JH, Ewing, B, Wang, Z, Timmer, M, Sultzer, D, Shekelle, PG (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA 306, 13591369.Google Scholar
Mandell, DJ, Unis, A, Sackett, GP (2011). Post-drug consequences of chronic atypical antipsychotic drug administration on the ability to adjust behavior based on feedback in young monkeys. Psychopharmacology (Berl) 215, 345352.Google Scholar
Miller, CJ, Li, M, Penfold, RB, Lee, AF, Smith, EG, Osser, DN, Bajor, L, Bauer, MS (2014). Patterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior. BMC Psychiatry 14, 339.Google Scholar
Ministry of Health and Welfare (2016). Cause of Death Statistics. Ministry of Health and Welfare: Taipei, Taiwan. (http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=474&fod_list_no=3443).Google Scholar
Mitchell, PB (2012). Bipolar disorder: the shift to overdiagnosis. Canadian Journal of Psychiatry 57, 659665.Google Scholar
Morgan, VA, McGrath, JJ, Jablensky, A, Badcock, JC, Waterreus, A, Bush, R, Carr, V, Castle, D, Cohen, M, Galletly, C, Harvey, C, Hocking, B, McGorry, P, Neil, AL, Saw, S, Shah, S, Stain, HJ, Mackinnon, A (2014). Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychological Medicine 44, 21632176.Google Scholar
National Health Insurance Administration (2004). National Health Insurance Annual Statistical Report. Bureau of National Health Insurance: Taipei, Taiwan. (https://www.nhi.gov.tw/Resource/webdata/20512_1_Attach_8661_1_s92.pdf).Google Scholar
National Health Insurance Administration (2011). The Report of Enrollment of National Health Insurance and Medical Health care Utilization of Alliens and Mainlanders. Bureau of National Health Insurance: Taipei, Taiwan. (http://www.nhi.gov.tw/Resource/webdata/19485_4_194%E5%9F%B7%E8%A1%8C%E5%A0%B1%E5%91%8A6%E6%9C%88%20(%E9%99%84%E9%8C%84%E4%BA%8C%E4%B9%8B%E9%99%84%E8%A1%A8).pdf).Google Scholar
National Health Insurance Administration (2017). Enrollment and Underwriting. Bureau of National Health Insurance: Taipei, Taiwan. (https://www.nhi.gov.tw/Resource/webdata/20517_2_201702_National%20Health%20Insurance%201.pdf).Google Scholar
National Institute for Health and Care Excellence (NICE) (2006). Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents in Primary and Secondary Care. National Collaborating Centre for Mental Health: London, UK.Google Scholar
Olfson, M, King, M, Schoenbaum, M (2015). Treatment of young people with antipsychotic medications in the United States. JAMA Psychiatry 72, 867874.Google Scholar
Pan, Y, Yeh, L, Chen, Y, Chan, H (2016 a). Three-year mortality in relation to early hospitalization and number of outpatient clinic visits in people with newly diagnosed bipolar disorder. General Hospital Psychiatry 43, 3237.Google Scholar
Pan, Y, Yeh, L, Chen, Y, Kuo, K, Chang, C (2016 b). Hospital treatment, mortality and healthcare costs in relation to socioeconomic status among people with bipolar affective disorder. British Journal of Psychiatry Open 2, 1017.Google Scholar
Reininghaus, U, Dutta, R, Dazzan, P, Doody, GA, Fearon, P, Lappin, J, Heslin, M, Onyejiaka, A, Donoghue, K, Lomas, B, Kirkbride, JB, Murray, RM, Croudace, T, Morgan, C, Jones, PB (2015). Mortality in schizophrenia and other psychoses: a 10-year follow-up of the ӔSOP first-episode cohort. Schizophrenia Bulletin 41, 664673.Google Scholar
Remington, G (2006). Schizophrenia, antipsychotics, and the metabolic syndrome: is there a silver lining? American Journal of Psychiatry 163, 11321134.Google Scholar
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 11231131.CrossRefGoogle ScholarPubMed
Taiwan's Ministry of the Interior (2017). Resident Population by 5-Year and 10-Year Age Group, 1990–2017. Taiwan's Ministry of the Interior: Taipei, Taiwan. (http://sowf.moi.gov.tw/stat/month/m1-06.xls).Google Scholar
Tarricone, I, Ferrari Gozzi, B, Serretti, A, Grieco, D, Berardi, D (2010). Weight gain in antipsychotic-naive patients: a review and meta-analysis. Psychological Medicine 40, 187200.Google Scholar
Tiihonen, J, Lonnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L, Tanskanen, A, Haukka, J (2009). 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374, 620627.Google Scholar
Wahlbeck, K, Westman, J, Nordentoft, M, Gissler, M, Laursen, TM (2011). Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry 199, 453458.Google Scholar
World Economic Outlook (WEO) data, IMF (2017). Implied PPP (Purchasing Power Parity) Conversion Rate. ECONSTATS: New York, USA. (http://www.econstats.com/weo/V013.htm).Google Scholar
Wu, CS, Tsai, YT, Tsai, HJ (2015). Antipsychotic drugs and the risk of ventricular arrhythmia and/or sudden cardiac death: a nation-wide case-crossover study. Journal of the American Heart Association 4, e001568.Google Scholar
Wu, CY, Chang, CK, Hayes, RD, Broadbent, M, Hotopf, M, Stewart, R (2012 a). Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register. Psychological Medicine 42, 15811590.Google Scholar
Wu, CY, Chen, YJ, Ho, HJ, Hsu, YC, Kuo, KN, Wu, MS, Lin, JT (2012 b). Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection. JAMA 308, 19061914.Google Scholar
Yatham, LN, Kennedy, SH, Parikh, SV, Schaffer, A, Beaulieu, S, Alda, M, O'Donovan, C, Macqueen, G, McIntyre, RS, Sharma, V, Ravindran, A, Young, LT, Milev, R, Bond, DJ, Frey, BN, Goldstein, BI, Lafer, B, Birmaher, B, Ha, K, Nolen, WA, Berk, M (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders 15, 144.CrossRefGoogle Scholar
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