A systematic review of mortality in schizophrenia

Oct 4 2007

As medical advances boost lifespans across the world, one group of people has been left out.

According to a new review of existing research, people with schizophrenia are falling further behind others when it comes to longevity.

“Put simply, on average, patients with schizophrenia are two to three times more likely to die compared to the general population,” said review co-author John McGrath, M.D., a professor at the Queensland Centre for Mental Health Research in Australia.

And, he said, the gap is growing.

An estimated 1 percent of all people are expected to develop schizophrenia during their lives; perhaps the most famous living person with the diagnosis is John Nash, the mathematician and subject of the book and film “A Beautiful Mind.”

Symptoms typically appear when people are in their 20s, McGrath said, and are more likely to strike men than women by a ratio of about 3 to 2.

People with schizophrenia suffer from hallucinations and what's called “disorganized” thinking. Medications can control symptoms fairly quickly, but they have numerous side effects, said Thomas McGlashan, M.D., a professor of psychiatry at Yale University.

In the new review, McGrath and colleagues examined 37 studies from 1980 to 2006 that explored death rates among people with schizophrenia. The studies were from 25 countries, including a number from the United States.

The researchers report their findings in the October 2007 issue of the Archives of General Psychiatry .

The researchers found that the death rate among people with schizophrenia was about 2.5 times that of other people. Suicide was the biggest risk: Schizophrenia patients were almost 13 times more likely to commit suicide than other people.

That number is a “tragic reflection on how suboptimal our current treatments are,” McGrath said.

Schizophrenic sufferers were also more likely to die of most other major causes of death, and the gap between death rates for people with schizophrenics and those without actually grew over time. McGrath thinks the divide may become even bigger in the future because newer medications for schizophrenia causes unhealthy side effects like weight gain and an increased risk of type 2 diabetes.

Why aren't people with schizophrenia doing better in an era of so many medical advances across the board? Psychiatrists blame medications for not doing more to help.

Many schizophrenic patients take their pills only sporadically because of their side effects.

“Probably the most pernicious (side effect) is that they take the ‘joie de vivre' out of life,” McGlashan said. Patients “just don't often feel alive or ‘with it' or motivated.”

As a result, many stop taking their medications and end up having symptoms again. “They have to be rehospitalized and put back on medication,” he said. “It becomes a revolving door.”

Even if people do take their schizophrenia medications, they have problems taking care of themselves when they become ill, McGlashan said. “They're less self aware, less motivated to do the kinds of things that are required for handling a lot of these disorders. Going to a doctor regularly, getting blood tests — they don't do it, even when they're on medication.”

Other possible factors may be at play, according to the review. Schizophrenic patients are more likely to engage in high-risk activities, and it may be possible that their genetic makeup makes them more prone to some illnesses like diabetes.

Overall, the report said, the findings “suggest that this already disadvantaged group is not benefiting from the improved health of the community in an equitable fashion. A systematic approach to monitoring and treating the physical health needs of people with schizophrenia is clearly warranted.”

Drug companies are trying to figure out how to stop the life-deadening effects of medications, McGlashan said. “But they're not really sure what causes that kind of reaction to begin with. It has something to do with the disorder, but it involves something different than the usual neurochemicals that the drugs target.”

He added that “in the long term, we're working hard to try to figure out a cause of this disorder. It's going to be a while. We don't know how long.”

Saha S, et al. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry 64(10), 2007.