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Chronic physical illnesses in patients with schizophrenia spectrum disorders are independently associated with higher rates of psychiatric rehospitalization; a cross-sectional study in Croatia

Published online by Cambridge University Press:  23 March 2020

I. Filipcic ,
I. Simunovic Filipcic ,
E. Ivezic ,
K. Matic ,
N. Tunjic Vukadinovic ,
S. Vuk Pisk ,
D. Bodor ,
Z. Bajic ,
M. Jakovljevic  and
N. Sartorius
I. Filipcic*
Affiliation:
Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia School of Medicine, University of Zagreb, Zagreb, Croatia
I. Simunovic Filipcic
Affiliation:
Department of psychological medicine, University Hospital Center Zagreb, Zagreb, Croatia
E. Ivezic
Affiliation:
Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
K. Matic
Affiliation:
Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
N. Tunjic Vukadinovic
Affiliation:
Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
S. Vuk Pisk
Affiliation:
Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
D. Bodor
Affiliation:
Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Z. Bajic
Affiliation:
Biometrika Healthcare Research, Zagreb, Croatia
M. Jakovljevic
Affiliation:
School of Medicine, University of Zagreb, Zagreb, Croatia Department of psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
N. Sartorius
Affiliation:
Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
*
*Corresponding author. Psychiatric hospital “Sveti Ivan”, Jankomir 11, pp68, 10 090 Zagreb, Croatia. E-mail address:igor.filipcic@pbsvi.hr (I. Filipcic).
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Abstract

Background:

Increased physical morbidity in patients with schizophrenia spectrum disorders (SSDs) is well documented. However, much less is known about the association between somatic comorbidities and psychosis treatment outcomes.

Subjects and methods:

This cross-sectional study, nested within the larger frame of a prospective cohort study, was done in 2016 at Psychiatric Hospital Sveti Ivan, Zagreb, Croatia. Data were collected on a consecutive sample of 301 patients diagnosed with schizophrenia spectrum disorders who achieved a stable therapeutic dosage. Key outcome was the number of psychiatric rehospitalizations since diagnosis of the primary psychiatric illness. Predictors were number of physical and psychiatric comorbidities. By robust regression, we controlled different clinical, sociodemographic, and lifestyle confounding factors.

Results:

The number of chronic somatic comorbidities was statistically significantly associated with a larger number of psychiatric rehospitalizations, even after the adjustment for number of psychiatric comorbidities and large number of other clinical, sociodemographic, and lifestyle variables.

Conclusions:

Chronic somatic comorbidities are associated with higher rates of psychiatric rehospitalization independently of psychiatric comorbidities and other clinical, sociodemographic, and lifestyle factors. Therefore, to treat psychosis effectively, it may be necessary to treat chronic somatic comorbidities promptly and adequately. Chronic somatic comorbidities should be considered equally important as the SSD, and should be brought to the forefront of psychiatric treatment and research with the SSD as one entity. The integrative approach should be the imperative in clinical practice.

Keywords

SchizotypalDelusionalMedical comorbidityPsychiatric comorbidityRehospitalizationSevere mental illness
Type
Original article
Information
European Psychiatry , Volume 43 , June 2017 , pp. 73 - 80
Copyright
Copyright © European Psychiatric Association 2017

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Footnotes

1

Igor Filipcic and Ivona Simunovic Filipcic have equally contributed to the paper (shared first authorship).

References

WHO, The world health report: mental health: new understanding Geneva: WHO; 2001.Google Scholar
Nasrallah, HAHarvey, PDCasey, DCsoboth, CTHudson, JIJulian, Let al.The management of schizophrenia in clinical practice (MOSAIC) registry: a focus on patients, caregivers, illness severity, functional status, disease burden and healthcare utilization. Schizophr Res 2015;166(1–3):69–79.CrossRefGoogle ScholarPubMed
Saha, SChant, DMcGrath, JA systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?. Arch Gen Psychiatry 2007;64(10):1123–1131.CrossRefGoogle ScholarPubMed
Walker, ERMcGee, REDruss, BGMortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 2015;72(4):334–341.CrossRefGoogle ScholarPubMed
Björkenstam, ELjung, RBurström, BMittendorfer-Rutz, EHallqvist, JWeitoft, GRQuality of medical care and excess mortality in psychiatric patients – a nationwide register-based study in Sweden. BMJ Open 2012;2:e000778.CrossRefGoogle ScholarPubMed
Laursen, TMNordentoft, MMortensen, PBExcess early mortality in schizophrenia. Annu Rev Clin Psychol 2014;10: 425–448.CrossRefGoogle Scholar
Lasić, DBevanda, MBošnjak, NUglešić, BGlavina, TFranić, TMetabolic syndrome and inflammation markers in patients with schizophrenia and recurrent depressive disorder. Psychiatr Danub 2014;26(3):214–219.Google ScholarPubMed
Olfson, MGerhard, THuang, CCrystal, SStroup, TSPremature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 2015;72(12):1172–1181.CrossRefGoogle ScholarPubMed
Kim, J-HChang, SMBae, JNCho, S-JLee, J-YKim, B-Set al.Mental-physical comorbidity in Korean adults: results from a nationwide general population survey in Korea. Psychiatry Invest 2016;13(5):496–503.CrossRefGoogle ScholarPubMed
De Hert, MCorrell, CUBobes, JCetkovich-Bakmas, MCohen, DAsai, Iet al.Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011;10(1):52–77.CrossRefGoogle ScholarPubMed
Gardner-Sood, PLally, JSmith, SAtakan, ZIsmail, KGreenwood, KEet al.Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial. Psychol Med 2015;45(12):2619–2629.CrossRefGoogle ScholarPubMed
Filipčić, IFilipčić IŠ, Matić, KLovretić, VIvezić, EBajić Ž, et al.Somatic comorbidities are independently associated with the poor health-related quality of life in psychiatric patients. Psychiatr Danub 2016;28(3):284–292.Google ScholarPubMed
Abraham, KMMiller, CJBirgenheir, DGLai, ZKilbourne, AMSelf-efficacy and quality of life among people with bipolar disorder. J Nerv Ment Dis 2014;202(8):583–588.CrossRefGoogle ScholarPubMed
Baumeister, HBalke, KHärter, MPsychiatric and somatic comorbidities are negatively associated with quality of life in physically ill patients. J Clin Epidemiol 2005;58(11):1090–1100.CrossRefGoogle ScholarPubMed
Miller, CJAbraham, KMBajor, LALai, ZKim, HMNord, KMet al.Quality of life among patients with bipolar disorder in primary care versus community mental health settings. J Affect Disord 2013;146(1):100–105.CrossRefGoogle ScholarPubMed
Briskman, IBar, GBoaz, MShargorodsky, MImpact of co-morbid mental illness on the diagnosis and management of patients hospitalized for medical conditions in a general hospital. Int J Psychiatry Med 2012;43(4):339–348.CrossRefGoogle ScholarPubMed
Mai, QHolman, CDJSanfilippo, FMEmery, JDThe impact of mental illness on potentially preventable hospitalisations: a population-based cohort study. BMC Psychiatry 2011;11:163.CrossRefGoogle ScholarPubMed
Munk Laursen, TMunk-Olsen, TGasse, CChronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder. PLoS One 692011.Google Scholar
Correll, CUDetraux, JDe Lepeleire, JDe Hert, MEffects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015;14(2):119–136.CrossRefGoogle ScholarPubMed
Fleischhacker, WWCetkovich-Bakmas, MDe Hert, MHennekens, CHLambert, MLeucht, Set al.Comorbid somatic illnesses in patients with severe mental disorders: clinical, policy, and research challenges. J Clin Psychiatry 2008;69(4):514–519.CrossRefGoogle ScholarPubMed
Smith, DJLangan, JMcLean, GGuthrie, BMercer, SWSchizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ Open 342013.Google Scholar
Sim, KChan, YHChua, THMahendran, RChong, SAMcGorry, PPhysical comorbidity, insight, quality of life and global functioning in first episode schizophrenia: a 24-month, longitudinal outcome study. Schizophr Res 2006;88(1–3):82–89.CrossRefGoogle ScholarPubMed
Lyketsos, CGDunn, GKaminsky, MJBreakey, WRMedical comorbidity in psychiatric inpatients: relation to clinical outcomes and hospital length of stay. Psychosomatics 2002;43(1):24–30.CrossRefGoogle ScholarPubMed
Chwastiak, LARosenheck, RAMcEvoy, JPKeefe, RSSwartz, MSLieberman, JAInterrelationships of psychiatric symptom severity, medical comorbidity, and functioning in schizophrenia. Psychiatr Serv 2006;57(8):1102–1109.CrossRefGoogle Scholar
Köhler, OPetersen, LBenros, MEMors, OGasse, CConcomitant NSAID use during antipsychotic treatment and risk of 2-year relapse – a population-based study of 16,253 incident patients with schizophrenia. Expert Opin Pharmacother 2016;17(8):1055–1062.CrossRefGoogle ScholarPubMed
Dixon, LPostrado, LDelahanty, JFischer, PJLehman, AThe association of medical comorbidity in schizophrenia with poor physical and mental health. J Nerv Ment Dis 1999;187(8):496–502.CrossRefGoogle ScholarPubMed
World Medical Association, World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310(20):2191–2194.Google Scholar
Conley, RRKelly, DLLove, RCMcMahon, RPRehospitalization risk with second-generation and depot antipsychotics. Ann Clin Psychiatry 2003;15(1):23–31.CrossRefGoogle ScholarPubMed
Lin, C-HLin, S-CChen, M-CWang, S-YComparison of time to rehospitalization among schizophrenic patients discharged on typical antipsychotics, clozapine or risperidone. J Chin Med Assoc 2006;69(6):264–269.CrossRefGoogle ScholarPubMed
de Castro, APWElkis, HRehospitalization rates of patients with schizophrenia discharged on haloperidol, risperidone or clozapine. Rev Bras Psiquiatr 2007;29(3):207–212.CrossRefGoogle Scholar
Herceg, MJukić, VVidović, DErdeljić, VCelić, IKozumplik, Oet al.Two-year rehospitalization rates of patients with newly diagnosed or chronic schizophrenia on atypical or typical antipsychotic drugs: retrospective cohort study. Croat Med J 2008;49(2):215–223.CrossRefGoogle ScholarPubMed
Burns, THospitalisation as an outcome measure in schizophrenia. Br J Psychiatry Suppl 2007;50:s37–s41.CrossRefGoogle Scholar
EUROSTAT. European Health Interview Survey (EHIS wave 2). Methodological manual [Internet]; 2013 Available from: https://www.google.hr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwi3mveGsvbPAhWFvhQKHbg9ANsQFggnMAA&url=http%3A%2F%2Fec.europa.eu%2Feurostat%2Fdocuments%2F3859598%2F5926729%2FKS-RA-13-018-EN.PDF%2F26c7ea80-01d8-420e-bdc6-e9d5f6578e7c&usg=AFQjCNHLe.Google Scholar
Catapano, ALGraham, IDe Backer, GWiklund, OChapman, MJDrexel, Het al.2016 ESC/EAS guidelines for the management of dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) developed with the special contribution of the Europea. Atherosclerosis 2016;253: 281–344.CrossRefGoogle Scholar
Finger, JDTafforeau, JGisle, LOja, LZiese, TThelen, Jet al.Development of the European Health Interview Survey – Physical Activity Questionnaire (EHIS-PAQ) to monitor physical activity in the European Union. Arch Public Health 2015;73:59.CrossRefGoogle ScholarPubMed
Baumeister, SERicci, CKohler, SFischer, BTöpfer, CFinger, JDet al.Physical activity surveillance in the European Union: reliability and validity of the European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ). Int J Behav Nutr Phys Act 2016;13:61.CrossRefGoogle Scholar
Owen-Smith, AStewart, CGreen, CAhmedani, BKWaitzfelder, BERossom, Ret al.Adherence to common cardiovascular medications in patients with schizophrenia vs. patients without psychiatric illness. Gen Hosp Psychiatry 2016;38: 9–14.CrossRefGoogle ScholarPubMed
Kansagara, DEnglander, HSalanitro, AKagen, DTheobald, CFreeman, Met al.Risk prediction models for hospital readmission: a systematic review. JAMA 2011;306(15):1688–1698.CrossRefGoogle ScholarPubMed
Viktil, KKBlix, HSMoger, TAReikvam, APolypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007;63(2):187–195.CrossRefGoogle ScholarPubMed
Jakovljević, MOstojić, LComorbidity and multimorbidity in medicine today: challenges and opportunities for bringing separated branches of medicine closer to each other. Psychiatr Danub. 2013;25(Suppl. 1):18–28.Google ScholarPubMed
Kalakonda, BKoppolu, PBaroudi, KMishra, APeriodontal systemic connections-novel associations – A review of the evidence with implications for medical practitioners. Int J Health Sci (Qassim) 2016;10(2):293–307.Google ScholarPubMed
Boyer, LMillier, APerthame, EAballea, SAuquier, PToumi, MQuality of life is predictive of relapse in schizophrenia. BMC Psychiatry 2013;13:15.CrossRefGoogle Scholar
Šprah, LDernovšek, MZWahlbeck, KHaaramo, PPsychiatric readmissions and their association with physical comorbidity: a systematic literature review. BMC Psychiatry 2017;17(1):2CrossRefGoogle ScholarPubMed
Kane, JMTreatment adherence and long-term outcomes. CNS Spectr 2007;12(10 Suppl. 17):21–26.CrossRefGoogle ScholarPubMed
Douzenis, ASeretis, DNika, SNikolaidou, PPapadopoulou, ARizos, ENet al.Factors affecting hospital stay in psychiatric patients: the role of active comorbidity. BMC Health Serv Res 2012;12:166.CrossRefGoogle ScholarPubMed
Stroup, TSMcEvoy, JPSwartz, MSByerly, MJGlick, IDCanive, JMet al.The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull 2003;29(1):15–31.CrossRefGoogle ScholarPubMed
Kopp, MFleischhacker, WWStürz, KRuedl, GKumnig, MRumpold, GPoor health behaviour and reduced quality of life of people treated with psychotropic drugs. Hum Psychopharmacol 2011;26(2):161–167.CrossRefGoogle ScholarPubMed
Olivares, JMSermon, JHemels, MSchreiner, ADefinitions and drivers of relapse in patients with schizophrenia: a systematic literature review. Ann Gen Psychiatry 2013;12(1):32CrossRefGoogle ScholarPubMed
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