The impact of cigarette smoking on life expectancy in schizophrenia, schizoaffective disorder and bipolar affective disorder: An electronic case register cohort study

Abstract Background Schizophrenia, schizoaffective disorder and bipolar affective disorder are associated with a life expectancy at birth that is 10–20 years shorter than in the general population. The prevalence of cigarette smoking in people with these disorders is very high, but the extent to which this accounts for differences in mortality is unclear. We addressed this issue by examining the effect of smoking on life expectancy and survival in a large electronic healthcare database of patients receiving secondary mental healthcare in South East London. Methods Data on all patients with a diagnosis of schizophrenia, schizoaffective disorder or bipolar affective disorder from 1st January 2007 to 31st December 2018 was obtained. Smoking status was determined using unstructured text data extracted from electronic health records. Chiang’s method of abridged life tables was used to calculate estimates of life expectancy at birth according to gender and most commonly recorded smoking status. Cox proportional hazards models were used to estimate mortality risk and adjusted for a broad range of demographic and clinical variables. Results 21,588 patients were included in the study of which 20,155 (93.4%) were classified as either smokers (16,717 [77.4%]) or non-smokers (3,438 (15.9%]). 2,434 (11.3%) participants died by the end of the observation period. In female patients, life expectancy at birth was 67.6 years in current smokers (95% CI: 66.4 to 68.8) and 74.9 years in non-smokers (95% CI: 72.8 to 77.0). In male patients, life expectancy at birth was 63.5 years in current smokers (95% CI: 62.5 to 64.5) and 68.5 years in non-smokers (95% CI: 64.4 to 72.6). Adjusted survival models showed that current smoking was associated with an increased risk of death, in both females (aHR = 1.42; 95% CI: 1.21–1.66) and males (aHR = 1.49; 95% CI: 1.25–1.79). Discussion Smoking may account for a substantial proportion of the reduced life expectancy in patients with psychotic disorders. Interventions to reduce tobacco smoking in patients with psychosis may therefore improve life expectancy in this group.

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Features of depressive and anxiety manifestations in the first episode of bipolar affective disorder

Archives of psychiatry ◽

10.37822/2410-7484.2019.25.3.142-146 ◽

2019 ◽

Vol 25 (3) ◽

pp. 142-146

Author(s):

Yu. I. Mysula

Keyword(s):

Affective Disorder ◽

Bipolar Affective Disorder ◽

First Episode ◽

Depression And Anxiety ◽

Men And Women ◽

Treatment And Prevention ◽

The Mean ◽

Gender Factor ◽

The Impact ◽

Mixed Variant

Background. The study of depression and anxiety in the first episode of BAR is important for the timely detection, treatment and prevention of poor diagnosis of the disease. Objective – the study of the features of depressive and anxiety symptoms of the first episode of bipolar affective disorder, taking into account the gender factor and the clinical type. Materials and methods. We have clinically examined 65 men and 88 women diagnosed with first episode (FE) of bipolar affective disorder (BAD). Results. In patients with depressive FE of BAD, all indicators, with the exception of the undifferentiated depression indicator, in men are slightly higher than in women: the overall indicator (respectively 22.55±3.61 points and 22.16±3.03 points); adynamic depression (17.41±2.62 points and 16.76±2.48 points); pervasive depression (9.75±3.13 points and 9.69±2.66 points); depression with fear (9.34±2.55 points and 9.51±2.27 points); undifferentiated depression (4.89±0.95 points and 5.01±1.22 points); in patients with the mixed variant are not significantly different: accordingly 15,83±2,64 points and 17,00±3,32 points; 11.00±1.67 points and 11.80±1.64 points; 6.67±1.63 points and 6.60±2.07 points; 7.33±1.21 points and 8.00±1.87 points; 3.67±1.03 points and 3.40±1.14 points; in patients with a manic type there are no signs of depression. The indicators of anxiety in men and women do not differ significantly: in the depressive variant, the total indicator was accordingly 21.41±7.01 points and 23.36±7.01 points; psychic anxiety – 13.25±3.86 points and 14.35±3.87 points; somatic anxiety – 8.16±4.05 points and 9.01±4.10 points; when mixed, accordingly, 20,00±4,52 points and 22,00±4,90 points; 13.33±3.27 points and 15.20±2.39 points; 6.67±3.27 points and 6.80±3.70 points; the manic variant showed no signs of anxiety. The mean Zung score for the depressed variant was 68.82±8.30 points and 65.97±8.41 points, accordingly, for the mixed one, 44.00±5.55 points and 50.40±5.32 points, accordingly, at a manic variant 2.13±1.64 points and 2.50±1.60 points. Conclusions. Differences in manifestations of depression and anxiety in the first episode of bipolar affective disorder are determined by the clinical option; the impact of gender on these manifestations is insignificant.

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The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-Year Diabetes Cohort Study

Diabetes Care ◽

10.2337/dc19-2137 ◽

2020 ◽

Vol 43 (8) ◽

pp. 1750-1758

Author(s):

Eric Yuk Fai Wan ◽

Weng Yee Chin ◽

Esther Yee Tak Yu ◽

Ian Chi Kei Wong ◽

Esther Wai Yin Chan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Life Expectancy ◽

Direct Medical Cost ◽

Medical Cost ◽

The Impact

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59 “Lithium Damaged My Spine” Might not Be a Delusion After All

CNS Spectrums ◽

10.1017/s1092852919000464 ◽

2019 ◽

Vol 24 (1) ◽

pp. 206-207

Author(s):

Muhammad Zaidi ◽

Anurag Prabhu ◽

Jose Perez Martell ◽

Sakshi Dhir

Keyword(s):

Affective Disorder ◽

Schizoaffective Disorder ◽

Patient Population ◽

Bipolar Affective Disorder ◽

Extensive Literature ◽

Negative Effects ◽

Mesh Terms ◽

First Choice ◽

History Of ◽

Bipolar Affective Disorders

AbstractBackgroundLithium remains to be the drug of choice for treating BPAD for the past few decades. There is extensive literature showing the effectiveness of Lithium when used as a mood stabilizing agent in bipolar spectrum disorders. However significant number of articles show that a third of the patients who receive lithium for their symptomology not only do not show any response but also may show deterioration of their clinical symptoms. (However, research shows that Lithium may negatively affect a third of the patients depending on various factors). The side effect profile of Lithium and especially its neurotoxic effects were discussed in depth in literature over the last decade. Although Lithium remains first choice as maintenance treatment for bipolar affective disorder, about half of all individuals may stop their treatment at some point, despite its proven benefits concerning the prevention of severe affective episodes and suicide.MethodsThe authors performed a systematic literature review to recognize the significance of negative effects of Lithium in a minority of patient population and also comment on the factors influencing patient compliance. We ran a literature search on Pubmed using the following terms: “Lithium” AND (“schizoaffective disorder [MeSH terms]” OR “Bipolar Affective disorder [MeSH terms]” ). Our inclusion criteria were studies which have observed effects of Lithium in schizoaffective patient population or bipolar affective patient population. Studies with other concurrent diagnoses were excluded.Case presentationWe discuss a fifty nine year old male with a history of multiple admissions to a forensic hospital care setting. He initially endorsed a diagnosis of Psychotic disorder NOS which was later changed to schizoaffective disorder during his subsequent admissions. He presented with affective psychotic features where his mood was labile shifting from melancholic to euphoric and a concurrent history of auditory verbal hallucinations. He displayed paranoid non-bizarre persecutory delusions and also alleged that one of his doctors had hated him and put him on Lithium as a form of punishment. He claims that Lithium, as a result, has significantly affected him negatively and also damaged his nerves. This led the authors to explore the significance of use of Lithiumin people with schizoaffective disorders and also bipolar affective disorders. We also discuss the disease course in the patient and his clinical response to use of various psychotropic medications.ConclusionsThe case exemplifies the negative effects of Lithium when used as a mood stabilizer in patient population that is susceptible to its adverse effects due to various factors.

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Prolactin ordering patterns in psychiatric inpatients and the impact this has on patient management

Australasian Psychiatry ◽

10.1177/1039856220934326 ◽

2020 ◽

pp. 103985622093432

Author(s):

Annabel S Jones ◽

Shoshana Sztal-Mazer ◽

Ilan Rauchberger ◽

Peter Shane Hamblin

Keyword(s):

Affective Disorder ◽

Clinical Management ◽

Bipolar Affective Disorder ◽

Clinical History ◽

First Episode ◽

Antipsychotic Treatment ◽

Asymptomatic Patients ◽

Episode Psychosis ◽

Alfred Hospital ◽

The Impact

Objective: Guidelines stipulate that baseline prolactin be ordered prior to commencing antipsychotic treatment to facilitate investigation of any subsequent hyperprolactinaemic symptoms. The aim was to observe when and why prolactin levels are ordered for psychiatry inpatients commencing or continuing antipsychotics and how this alters clinical management. Methods: Psychiatry inpatients admitted to the Alfred Hospital, Melbourne, Australia, in 2018 with the diagnoses of psychosis, schizophrenia, schizo-affective disorder or bipolar affective disorder were retrospectively analysed. Results and clinical history data were collected in patients in whom prolactin was ordered during or within 12 months of the relevant admission. Results: Of 592 patients admitted during this period, 90 had prolactin ordered. Eight (8.9%) of the 90 tests were for hyperprolactinaemic symptoms, while the remainder were routine blood work. The results altered clinical management in 10 of the 90 (11.1%) patients. Of these 10, 8 were symptomatic. In the six patients with first episode psychosis, only one had prolactin ordered prior to antipsychotic commencement. Conclusions: Adherence to guideline recommendations of baseline prolactin testing was poor. When established on antipsychotics, measuring prolactin rarely changed management in asymptomatic patients; however, it did in those with hyperprolactinaemic symptoms. Measuring prolactin in asymptomatic patients on antipsychotics appears unhelpful.

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Cognitive impairment in the euthymic phase of affective disorder

Psychological Medicine ◽

10.1017/s0033291798006862 ◽

1998 ◽

Vol 28 (5) ◽

pp. 1027-1038 ◽

Cited By ~ 196

Author(s):

LARS VEDEL KESSING

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairment ◽

Affective Disorder ◽

Bipolar Affective Disorder ◽

Cognitive Outcome ◽

Case Register ◽

Single Episode ◽

Icd 10 ◽

And Gender ◽

Bipolar Patients

Background. A review of studies of cognition in the euthymic phase of unipolar and bipolar affective disorder reveals diverging results.Methods. The study was designed as a controlled cohort study, with the Danish psychiatric case register of admissions used to identify patients and the Danish civil register to identify controls. Patients who were hospitalized between 19 and 25 years ago with an affective diagnosis and who at interviews fulfilled criteria for a primary affective unipolar or bipolar disorder, according to ICD-10, were compared with age- and gender-matched controls. Interviews and assessment of the cognitive function were made in the euthymic phase of the disorder. In all, 118 unipolar patients, 28 bipolar patients and 58 controls were included. Analyses were adjusted for differences in the level of education and for subclinical depressive and anxiety symptoms.Results. Patients with recurrent episodes were significantly more impaired than patients with a single episode and more impaired than controls. Also, within patients the number of prior episodes seemed to be associated with cognitive outcome. There was no difference in the severity of the dysfunction between unipolar and bipolar patients.Conclusions. Cognitive impairment in out-patients with unipolar and bipolar disorder appears to be associated with the number of affective episodes.

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The Impact of Cigarette Smoking on Asthma: A Population-Based International Cohort Study

International Archives of Allergy and Immunology ◽

10.1159/000330900 ◽

2012 ◽

Vol 158 (2) ◽

pp. 175-183 ◽

Cited By ~ 54

Author(s):

Isa Cerveri ◽

Lucia Cazzoletti ◽

Angelo G. Corsico ◽

Alessandro Marcon ◽

Rosanna Niniano ◽

...

Keyword(s):

Cohort Study ◽

Cigarette Smoking ◽

Population Based ◽

The Impact

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Association of cigarette smoking with a past history and incidence of herpes zoster in the general Japanese population: the SHEZ Study

Epidemiology and Infection ◽

10.1017/s0950268816003174 ◽

2017 ◽

Vol 145 (6) ◽

pp. 1270-1275 ◽

Cited By ~ 4

Author(s):

J. BAN ◽

Y. TAKAO ◽

Y. OKUNO ◽

Y. MORI ◽

H. ASADA ◽

...

Keyword(s):

Cohort Study ◽

Herpes Zoster ◽

Cigarette Smoking ◽

Regression Model ◽

Smoking Status ◽

Past History ◽

Baseline Survey ◽

History Of ◽

Never Smokers ◽

The Impact

SUMMARYFew studies have examined the impact of cigarette smoking on the risk for herpes zoster. The Shozu Herpes Zoster (SHEZ) Study is a community-based prospective cohort study over 3 years in Japan aiming to clarify the incidence and predictive and immunological factors for herpes zoster. We investigated the associations of smoking status with past history and incidence of herpes zoster. A total of 12 351 participants provided valid information on smoking status and past history of herpes zoster at baseline survey. Smoking status was classified into three categories (current, former, never smoker), and if currently smoking, the number of cigarettes consumed per day was recorded. The participants were under the active surveillance for first-ever incident herpes zoster for 3 years. We used a logistic regression model for the cross-sectional study on the association between smoking status and past history of herpes zoster, and a Cox proportional hazards regression model for the cohort study on the association with risk of incidence. The multivariable adjusted odd ratios (95% CI) of past history of herpes zoster for current vs. never smokers were 0·67 (0·54–0·80) for total subjects, 0·72 (0·56–0·93) for men and 0·65 (0·44–0·96) for women. The multivariable adjusted hazard ratios (95% CI) of incident herpes zoster for current vs. never smokers were 0·52 (0·33–0·81) for total subjects, 0·49 (0·29–0·83) for men and 0·52 (0·19–1·39) for women. Smoking status was inversely associated with the prevalence and incidence of herpes zoster in the general population of men and women aged ⩾50 years.

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