Decades of research show that people with schizophrenia have an increased risk of death from cancer; however, the relationship between schizophrenia and cancer incidence remains less clear. This population-based study investigates the incidence of seven common types of cancer among people with a hospital diagnosis of schizophrenia and accounting for the effects of age, sex and calendar time.

This population-based study used 1990–2013 data from three nationwide Swedish registries to calculate the incidence (in total, by age group and by sex) of any cancer and of lung, oesophageal, pancreatic, stomach, colon, (in men) prostate and (in women) breast cancer in 111 306 people with a hospital diagnosis of schizophrenia. The incidence in people with diagnosed schizophrenia was compared with the incidence in the general population. Risk estimates accounted for the effects of calendar time.

In 1 424 829 person-years of follow-up, schizophrenia did not confer an overall higher cancer risk (IRR 1.02, 95% CI 0.91–1.13) but was associated with a higher risk for female breast (IRR 1.19, 95% CI 1.12–1.26), lung (IRR 1.42, 95% CI 1.28–1.58), oesophageal (IRR 1.25, 95% CI 1.07–1.46) and pancreatic (IRR 1.10, 95% CI 1.01–1.21) and a lower risk of prostate (IRR 0.66, 95% CI 0.55–0.79) cancer. Some age- and sex-specific differences in risk were observed.

People with schizophrenia do not have a higher overall incidence of cancer than people in the general population. However, there are significant differences in the risk of specific cancer types overall and by sex calling for efforts to develop disease-specific prevention programmes. In people with schizophrenia, higher risk generally occurs in those <75 years.

Suicide risk is increased in patients with a history of psychiatric hospitalization.

To explore how suicide risk varies by age during psychiatric hospitalization and in the year post-discharge.

This is a population-based case-control study of all suicides (n = 20,675; 70% male) in Sweden aged ≥18 years during 1991–2003. Each suicide was individually matched to 10 population controls by age, sex, and county of residence. Discharge diagnoses of a mental disorder (except dementia and other organic disorders) in the year prior to suicide were identified by register linkage. Odds ratios (OR) were calculated by conditional logistic regression to estimate the relative risk of suicide in those with psychiatric diagnoses compared to the general population. ORs were estimated by age group (18–34 years, 35–49 years, 50–64 years, and ≥ 65 years) and timing of the suicide in relation to discharge.

During hospitalization, the youngest age group had the greatest suicide risk elevation [OR 64 (95% CI 44-92)]. In the first month post-discharge, the oldest age group had the highest suicide risk elevation [OR 162 (95% 66–399) in the first week and OR 127 (95% 67–242) in the second to fourth weeks]. In the remaining eleven months, suicide risk elevation was lower and relatively similar in different age groups.

During the year following psychiatric hospitalization, an especially high attention should be paid to the suicide risk of the elderly patients in the first month post-discharge.

Several studies from different countries demonstrate that cardiovascular mortality is the main cause of death for schizophrenia patients as well as for the population although patients with schizophrenia have a doubled cardiovascular mortality risk. The general population of Sweden has during recent years experienced remarkable declines in mortality from cardiovascular disease resulting in increased overall life expectancy. It is unclear whether patients with schizophrenia have experienced these benefits.

Standardized mortality ratios (SMR) for schizophrenia patients in Sweden during 1970 through 2003 were analyzed, using data from national registers on diagnosis and causes of death. Secular trends for SMR were calculated in Poisson regression models.

SMR was for schizophrenia patients for all causes of death 2.33 for men and 2.35 for women, cardiovascular death 2.08 for men and 2.15 for women, coronary heart disease 1.91 for men and 2.06 for women, and for myocardial infarction 1.75 for men and 1.86 for women. Age-standardized mortality ratios for schizophrenia patients increased significantly (p<0.001) for both men and women for all causes of death, cardiovascular disease, coronary heart disease and acute myocardial infarction. Among schizophrenia patients, there were 3,410 excess deaths from cardiovascular causes.

The substantial improvements in recent years in mortality from cardiovascular disorders in the general population were not observed among patients with schizophrenia. For the medical care system and for psychiatry the increasing differences in mortality from cardiovascular disease between the general population and patients with schizophrenia are a major clinical and public health concern.

Accumulating evidence supports the hypothesis that antidepressant treatment prevents suicide. Most of this evidence consists of studies demonstrating decreases in suicide in parallel with increased use of antidepressants in different populations. Since ecological studies cannot establish causality, this individual-based study, analyzing temporal patterns in the toxicology of all suicides in Sweden 1992-2005, aimed at testing the hypothesis that the substantial decrease in suicide during the period was caused by the increased use of antidepressants.

During the eleven years, 16,937 suicides, and 33,426 controls (natural or accidental deaths) were investigated by toxicological screening. The annual numbers of detections of antidepressants, zolpidem, zopiclone, tramadole, and dextropropoxyphene were analysed in suicides and controls.

The annual number of suicides decreased by 332 cases (18.6 %). The expected number of antidepressant positive suicides, as determined only by their increased use in controls, was 741. If the decrease in suicide was caused by antidepressants, the expected number of suicides with antidepressants in toxicology should be reduced with 332 cases i.e. 409. If the decrease in suicide was not caused by antidepressants the expected number of positive cases should be reduced by 18.6 %, i.e. 603. The observed number was 420, indicating causality. The other drugs were detected as expected if they had not caused the decrease in suicide.

This controlled individual-based naturalistic study indicates that the increased use of antidepressants was the cause of the decrease in suicide previously demonstrated in ecological studies. Definite conclusions cannot be drawn, however.

Bipolar Disorder type 1 (BP-1) is a severe and common psychiatric disorder with a strong genetic contribution to increased disease risk. Heritability is around 60% and at least a dozen different genes seems to be involved in the etiology. The DAOA-G72/G30) locus on chromosome 13p22-34 has been associated with BP-1 in at least six independent datasets, although there are different SNPs and haplotypes associated with increased disease risk in these studies.

276 Swedish patients with BP-1, diagnosed according to DSM-IV, and 940 controls were analyzed with 36 SNPs from eight previously reported candidate genes for bipolar disorder (DAOA-G72/G30, P2RX7, COMT, BDNF, CAMKK2, GRK3, SLC6A4 and S100A10). Genotyping was carried out with Applied Biosystems TaqMan® using ABI PRISM® 7900HT Sequence Detecting System. Statistical analysis was performed with the Unphased program.

None of the SNPs showed a significant association by itself. However, three SNPs in different haplotype blocks in the DAOA-G72/G30 genes were together associated to bipolar disorder (p=0.0009). The association remained when different SNPs in each haplotype block were analyzed.

This is the first study of the G72/30 gene in a homogeneous Swedish BP-1 sample. We found a strong association, which required SNPs from three different haplotype blocks. Thus, the association between the DAOA-G72/G30 genes and Swedish patients with BP-1 disorder was more complex than previous findings.

There is evidence that patients with bipolar disorder have an increased mortality from somatic causes of death, including coronary heart disease and myocardial infarction. However, present mortality ratios and mortality trends over time are not known.

To analyze relative mortality and mortality trends for patients with bipolar disorder in relation to the population for cerebrovascular disease, coronary heart disease and myocardial infarction.

All patients in Sweden with a clinical diagnosis of bipolar disorder from the introduction of ICD-10 (1987–2006) found in the National Swedish Patient Register were followed-up in the Cause of death register. Mortality rate ratios (MRR) for different cardiovascular diseases and different age groups were calculated, as well as numbers of excess deaths, relative to the population. Also, admission rate ratios (ARR) and yearly mortality rates for bipolar patients versus the population were calculated for the same time period.

From all causes of death, there were 5,471 deaths for bipolar patients. MRR was 2.58 (95% CI: 2.51–2.65). For cerebrovascular disease MRR was 2.19 (95% CI: 2.01–2.40), and for coronary heart disease MRR was 2.10 (95% CI: 1.98–2.2.24). In the subgroup of acute myocardial infarction MRR was 1.97 (95% CI: 1.81–2.14). In cerebrovascular disease, ARR was increased to 1.47 (95% CI: 1.35–1.59), while in coronary heart disease ARR was 1.06 (95% CI: 0.98–2.24), and in acute myocardial infarction 1.09 (95% CI: 0.0.98–1.22). Yearly mortality rates for these causes of death decreased both among patients and the population, without indication of a decreasing gap.

In patients with bipolar disorder, mortality from cerebrovascular disease and coronary heart disease with its subgroup acute myocardial infarction was doubled during 1987–2006. In contrast, admission rates for coronary heart disease and acute myocardial infarction were not increased. Yearly mortality rates decreased both for the patients and the population, but there were no indications of a decreasing gap.

Bipolar disorder; Register study; Cerebrovascular disease; Coronary heart disease; Acute myocardial infarction; Mortality rate ratios; Admission rate ratios.

Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of how pharmacotherapy is related to suicide risk is limited.

To explore suicide risk in relation to prescription of antipsychotics and antidepressants.

Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4,000), patients who died by suicide within five years from diagnosis were defined as cases (n = 84; 54% male). Individual matching was performed with schizophrenia controls from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Odds ratios (OR) of the association between medication and suicide risk were calculated by conditional logistic regression.

No significant association was observed between suicide and having ever been prescribed any antidepressant (33 cases and 30 controls) or any antipsychotic (83 cases and 82 controls). A lower suicide risk was found in patients who had ever been prescribed a second generation antipsychotic (risperidone, ziprazidone, olanzapine or clozapine; 12 cases and 23 controls): OR 0.2 (95% confidence interval [CI], 0.1–0.7). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.1 (95% CI, 0.03–0.6).

The lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these medications, to differences in compliance, or to differences in other characteristics associated with a lower suicide risk.

The International Diabetes Federation (IDF)(2004) has defined criteria for metabolic syndrome and in patients with schizophrenia four of ten meet the criteria for having the syndrome. Its important too study more about the influence of metabolic syndrome because there association with high morbidity and increased risk of influence on patients health and the treatment itself The aim of the study was to investigate metabolic risk factors influence on quality of life. The method was a prospective cohort study from specialized psychiatric outpatients departments in Sweden. The study recruits consecutively patients diagnosed with schizophrenia and other long-term psychotic disorders (ICD10). A prospective population based study is serving as a control group. Patients are assessed with a psychiatric questionnaire witch included CGI and GAF. Health-related quality of life assessed using the questionnaire EQ5D both in patients and population and health status with BMI, smoke habits and alcohol consume.

The results on patients (n = 777) and population (n = 7238) showed significant differences in lower EQ5D Index in man especially in younger age. The diagnosis of schizophrenia and schizoaffective were the most common in the patient group (n = 481). In patients was nearly 50% non alcoholic users compared to the control group (=population) were the non consumers was 18%. BMI over 35 were more common in the patient group than in the population 13.2% versus 2.8%.

In conclusion there were differences in quality of life between metabolic risk patients with psychosis and the control group.

In bipolar disorder, hospital treatment is generally required in acute manic episodes, due to lack of compliance and adherence to treatment, and in episodes with marked depressive symptoms, especially suicidal ideation. Analyzing patterns of hospital admission rates is important in order to estimate treatment outcomes in both the acute and remitting phases of the disease. The aim of this study was to analyze secular trends in admissions and re-admissions for bipolar disorder in Sweden.

For bipolar disorder and its subdiagnoses, the number of admissions, length of stay and days in hospital during 1997-2005 was calculated. Readmission rates over five years were calculated for patients discharged for the first and the second time during 2000.

The number of admissions for patients with bipolar disorder in Sweden increased from around 3,500 to more than 4,000, partly explained by increasing rates of first admissions. Three fourths were readmissions. Hospital days increased, since the length of stay was not reduced. Manic episodes represented half the hospitalizations, depressive a quarter, and mixed ten percent. Patients with their second admission had 1.9 readmissions during five years, compared to 1.2 for patients with their first admission in 2000.

Physicians should consider early and effective treatment with long term outcomes in mind. The progressive course is clearly shown by the increasing rates of readmissions after the second admission compared to the first. The increasing number of first admissions is an indication that more patients have received a bipolar disorder diagnosis.

Suicide seasonality with a peak incidence in spring or early summer has been consistently reported. Although a quite robust finding this spring peak of suicides is poorly understood. The effect of climate parameters such as sunlight, temperature, humidity etc. on hormones and neurotransmitters such as serotonin has been hypothesized to explain the seasonal variation in suicide.

To examine the amplitude of suicide seasonality in relation to sunlight duration and serotonergic medication.

By using Swedish Registers we gathered information including forensic data on antidepressive medication for 11,845 suicides during 1992 to 2003. Moreover, data for sunlight duration for the same period for all Swedish counties was obtained from the Swedish Meteorological and Hydrological Institute. The presence of suicide seasonality was estimated with a Poisson regression variant, in three groups, as defined by tertiles of sunlight duration.

In regions with low sunlight duration no statistically significant seasonality pattern was found for men independently of medication. In regions with middle or high sunlight duration an increased amplitude of seasonality was observed among men treated with SSRIs in a dose dependent pattern. Such a pattern was not observed among suicide victims on other antidepressant medication or those without an antidepressant. Women on the other hand showed a seasonal variation in suicide only in regions with low sunlight duration.

Suicide seasonality amplitude increases with higher sunlight duration especially in men treated with SSRIs. In women, the highest suicide seasonality was observed in regions with the lowest sunshine duration.

There is limited information published on the specific financial costs of completed and/or attempted suicide in bipolar patients. In the last 15 years, only 6 studies were published. Their results vary considerably due to differences in methods used. Also, information on cost for pure manic versus mixed episodes is lacking. This is surprising, since studies have shown that suicidal behaviour is more common among patients with depressive symptoms than with pure mania, and this difference increases considerably when the mixed-features specifier is applied.

We conducted a registry study with the aim to expand the epidemiological information on suicidal behaviour by episode type in bipolar disorder, and its associated costs.

Health data were retrieved from the Swedish Patient Register. Data covered the period 1990–2014 and included the number of discharged patients with bipolar diagnosis, hospital re-admissions, and attempted and/or completed suicides. Moreover, we retrieved data on suicide and cause of death from the Swedish Cause of Death register. Analyses were done for the whole sample and stratified by subtypes (mania, depression and mixed forms).

First results will be presented at the EPA meeting.

This is a nation-wide Swedish study of completed and attempted suicide in bipolar patients. The hypothesis we will test is that there is a substantial variation between different bipolar disorder subtypes, and that most of the expenditures due to suicidal behaviour in bipolar disorder are linked to mixed forms, mania in combination with depression.

The authors have not supplied their declaration of competing interest.

People who have schizophrenia die earlier from somatic diseases than do people in the general population, but information about cardiovascular deaths in people who have schizophrenia is limited. We analysed mortality in all age groups of people with schizophrenia by specific cardiovascular diseases (CVDs), focusing on five CVD diagnoses: coronary heart disease, acute myocardial infarction, cerebrovascular disease, heart failure and cardiac arrhythmias. We also compared hospital admissions for CVDs in people who had schizophrenia with hospital admissions for CVDs in the general population.

This national register study of 10 631 817 people in Sweden included 46 911 people who were admitted to the hospital for schizophrenia between 1 January 1987 and 31 December 2010. Information from national registers was used to identify people who had schizophrenia and obtain data about mortality, causes of death, medical diagnoses and hospitalisations.

CVDs were the leading cause of death in people who had schizophrenia (5245 deaths), and CVDs caused more excess deaths than suicide. The mean age of CVD death was 10 years lower for people who had schizophrenia (70.5 years) than the general population (80.7 years). The mortality rate ratio (MRR) for CVDs in all people who had schizophrenia was 2.80 (95% confidence interval (CI) 2.73–2.88). In people aged 15–59 years who had schizophrenia, the MRR for CVDs was 6.16 (95% CI 5.79–6.54). In all people who had schizophrenia, the MRR for coronary heart disease was 2.83 (95% CI 2.73–2.94); acute myocardial infarction, 2.62 (95% CI 2.49–2.75); cerebrovascular disease, 2.4 (95% CI 2.25–2.55); heart failure, 3.25 (95% CI 2.94–3.6); and cardiac arrhythmias, 2.06 (95% CI 1.75–2.43). Hospital admissions for coronary heart disease were less frequent in people who had schizophrenia than in the general population (admission rate ratio, 0.88 (95% CI 0.83–0.94). In all age groups, survival after hospital admission for CVD was lower in people who had schizophrenia than in the general population.

People who had schizophrenia died 10 years earlier from CVDs than did people in the general population. For all five CVD diagnoses, mortality risk was higher for those with schizophrenia than those in the general population. Survival after hospitalisation for CVDs in people who had schizophrenia was comparable with that of people in the general population who were several decades older.