Institutionen för klinisk neurovetenskap / Department of Clinical Neuroscience
Abstract
Patients with psychiatric disorders such as schizophrenia, bipolar
disorder and unipolar disorder have a considerably increased mortality
compared to the population. To reduce this increased mortality is a major
task for clinical psychiatry, and the aim of this study is to improve the
knowledge about the increased mortality in order to reduce its effects
for the patients. The studies in this thesis are based upon register
linkages. Information about diagnosis and time of admission and discharge
from the Patient register has been linked with information about cause
and time of death from the Cause-of-death register, and information about
first-degree relatives from the Second-generation register.
First admissions with schizophrenia in Stockholm County during 1978 to
1994 were reduced by 1.3% yearly for males and 1.9% for females, while
first admissions with either schizophrenia or paranoid psychosis were
unchanged for both sexes, indicating that the reduction of first
schizophrenia admissions may be an effect of diagnostic changes during
the study period.
For schizophrenics in Stockholm County followed-up from the first
diagnosis, standardized mortality ratios (SMR:s) for all causes of death
were increased to 2.8 for males and 2.4 for females. SMR was most
increased in suicide, with 15.7 for males and 19.7 for females, and in
unspecified violence, with 11.7 for males and 9.9 for females. SMR:s for
suicide were particularly increased for young patients during the first
year after the first admission. More excess deaths were caused by natural
(somatic) than by unnatural causes of death, although the specific causes
of death that caused most extra deaths were suicide in males and
cardiovascular disease in females.
Time trends in SMR for all causes of death during 1976 to 1995, for
patients in Stockholm County diagnosed with schizophrenia for the first
time, increased 1.7 times for males and 1.3 times for females.
Cardiovascular death increased 4.7 times for males and 2.7 times for
females, while all unnatural causes of death increased 1.8 times for
males and suicide increased 1.9 times for females. The increase in
mortality may be an effect of the concomitant reduction with 64% of days
in hospital for schizophrenia.
SMR:s for all patients with a hospital diagnosis of bipolar or unipolar
disorder in Sweden for all causes of death were 2.5 for males and 2.7 for
females in bipolar disorder, and 2.0 for both sexes in unipolar disorder.
SMR:s for suicide in bipolar disorder were 15.0 for males and 22.4 for
females, and in unipolar disorder 20.9 and 27.0 respectively. In bipolar
disorder, most extra deaths were caused by natural causes, while in
unipolar disorder, unnatural causes caused most extra deaths. Time trends
for suicide mortality increased, both for bipolar and unipolar disorder.
SMR:s for suicide for siblings to patients with schizophrenia, bipolar or
unipolar disorder were not increased, unless the siblings had a
psychiatric diagnosis of their own. Siblings with psychiatric diagnoses
had as high suicide mortality as the probands. However, previous suicide
in the family increased the suicide risk for patients with schizophrenia
and bipolar disorder, but not unipolar disorder