Impact of mental health problems on case fatality in male cancer patients

Background: Although mortality rates are elevated in psychiatric patients relative to their healthy counterparts, little is known about the impact of mental health on survival in people with cancer. / Methods and results: Among 16 498 Swedish men with cancer, survival was worse in those with a history of psychiatric hospital admissions: multiply-adjusted hazard ratio (95% confidence interval) comparing cancer mortality in men with and without psychiatric admissions: 1.59 (1.39, 1.83). / Conclusion: Survival in cancer patients is worse among those with a history of psychiatric disease. The mechanisms underlying this association should be further explored

Medical Burden in Late-Life Bipolar and Major Depressive Disorders

Background: Elderly patients with bipolar disorder have been found to have higher mortality than those with major depressive disorder. The authors compare medical burden in elderly patients with bipolar disorder with that in those with major depressive disorder. Methods: Fifty-four patients with bipolar I or II disorder who were 60 years of age and older were equated l-to-2 to 108 patients with nonpsychotic, major depressive disorder according to age, sex, race, and lifetime duration of mood disorder illness. Variables examined included the following: Cumulative Illness Rating Scale for Geriatrics (CIRS-G) total scores, body mass index (BMI), and CIRS-G subscale scores. Results: Compared with patients with major depressive disorder, patients with bipolar disorder had similar levels of general medical comorbidity on the CIRS-G total score and number of systems affected but higher BMI. After controlling for multiple comparisons, the endocrine/metabolic and respiratory subscale scores on the CIRS-G were higher for patients with bipolar disorder. Conclusion: Although overall medical burden appears comparable in elderly patients with bipolar and those with major depressive disorder, patients with bipolar disorder have higher BMI and greater burden of endocrine/metabolic and respiratory disease. © 2008 American Association for Geriatric Psychiatry

Metabolic Issues in patients affected by Schizophrenia:Clinical characteristics and Medical Management

Patients affected by psychotic disorders are more likely to develop high rates of co-morbidities , such as obesity, type 2 diabetes, dyslipidemias, hypertension, metabolic syndrome, myocardial infarction, stroke etc. in the long-term. These morbidities have a significant impact on the life-expectancy of these patients. Patients with chronic psychoses show a two- to three-fold increased risk of death mostly from cardiovascular and metabolic diseases. Although there may be an independent link between schizophrenia and metabolic conditions, the cardio-metabolic risk is mostly related to an unhealthy lifestyle and the usage of antipsychotic agents (especially Second Generation Antipsychotics or atypical) even when these remain effective treatments in the management of major psychoses. Recently many international organizations have developed screening and monitoring guidelines for the control of modifiable risk factors in order to reduce the rate of co-morbidity and mortality among patients affected by schizophrenia. This paper is a review of current knowledge about the metabolic issues of patients affected by schizophrenia and describes clinical characteristics and medical management strategies for such conditions

The impact of obesity on health care costs among persons with schizophrenia

BACKGROUND: Obesity is the second leading cause of preventable death in the US, and is twice as common among individuals with schizophrenia as the general population. METHODS: Data from the Clinical Antipsychotic Trials of Intervention Effectiveness, a multi-site trial of antipsychotic pharmacotherapy in 1400 patients with schizophrenia was used to examine the relationships between body mass index (BMI) and medical costs. RESULTS: ANCOVA analyses found significant increases in both psychiatric and non-psychiatric medication costs associated with increasing BMI, and a significant, but smaller, difference in costs of outpatient medical-surgical service utilization: $41 per month for morbidly obese patients compared to$26 per month for patients of normal weight (F=2.4, p = 0.04). In multivariable logistic regression analyses, morbid obesity was associated with significantly increased odds of any outpatient medical-surgical service costs. When compared to observations of BMI>35, BMI observations within the normal range (18.5–24.9) were half as likely to be associated with any outpatient medical-surgical costs (OR 0.53, 95% CI 0.45, 0.63). CONCLUSIONS: In this large sample of persons with schizophrenia, obesity was associated with increased outpatient general medical service and medication costs even after controlling for demographic characteristics and medical co-morbidity, but the absolute dollar amount was small