Cohort Of Psychiatric Patients Research Articles

P02-569 - Sudden death in psychiatric patients

IntroductionStudies using death certificates have indicated an excess of sudden cardiac deaths among users of antipsychotic drugs compared to the general population, but may have underestimated the presence of other known causes of sudden and unexpected death.ObjectivesTo assess the cause and risk factors for sudden death discovered by contemporaneous investigation of all deaths occurring over a 26-year period (1984–2009) in adult patients registered for care in one large psychiatric hospital in New York.MethodsCircumstances of death, psychiatric diagnoses, psychotropic drugs and past medical history were extracted from the root cause analyses of sudden unexpected deaths. After the exclusion of suicides, homicides and drug overdoses, explained and unexplained cases were compared regarding clinical variables and the utilization of antipsychotics.ResultsOne hundred cases of sudden death were identified among of 119, 500 patient-years. The death remained unexplained in 52 cases. The incidence of unexplained sudden death was 125/100,000 (95% CI 88.9–175.1/100,000) patient-years in 2005–2009, 53/100,000 (95% CI 31.7–88.5/100,000) patient-years in 1999–2004 and 7/100,000 (95% CI 3.7–19.4/100,000) patient-years in 1984–1998. Explained and unexplained cases were similar regarding psychiatric diagnoses and treatment with any psychotropic class, including first- and second-generation antipsychotics. Dyslipidemia (p = 0.012), diabetes (p = 0.055) and co-morbid dyslipidemia and diabetes (p = 0.008) were more common in the unexplained than in the explained cases.ConclusionsIn a consecutive cohort of psychiatric patients, the unexplained sudden deaths were associated with known risk factors for coronary artery disease, but not with higher utilization of first- or second-generation antipsychotics.

P02-568 - Prediabetes in patients treated with antipsychotic drugs

BackgroundIn 2010, the American Diabetes Association (ADA) proposed that individuals with fasting glucose 100–125 mg/dl (5.6-6.9 mmol/l) or glucose 140–199 mg/dl (7.8–11.0 mmol/l) 2 hours after a 75 gm oral glucose tolerance test (OGGT) or hemoglobin A1c (A1c) 5.7–6.4% be classified as prediabetic to indicate a high risk for the development of diabetes.ObjectiveTo determine the prevalence of prediabetes in psychiatric patients receiving antipsychotics and to compare the clinical and metabolic features of patients with normal glucose tolerance, prediabetes and diabetes.MethodThe 2010 ADA criteria were applied to a large consecutive cohort of psychiatric patients treated at one institution in Belgium. All patients were evaluated with OGTT, A1c, insulin levels and lipid profiles.ResultsThe study sample was restricted to the 783 adult patients (mean age 37.6) without known history of diabetes. 413 (52.8%) patients had normal glucose tolerance, 290 (37%) were prediabetic and 80 (10.2%) were diabetic. The 3 groups were similar with regard to psychiatric diagnoses, severity of mental illness and antipsychotic treatment. A statistically significant crescendo gradient from normal to prediabetes and from prediabetes to diabetes was observed for age, body mass index, waist circumference, fasting insulin, homeostatic model of insulin resistance (HOMA-IR) and triglyceride levels. The intergroups differences for fasting insulin and HOMA-IR were confirmed for treatment with clozapine, olanzapine, quetiapine, risperidone and amilsulpride, but not for aripiprazole or first-generation antipsychotics.ConclusionPrediabetes is highly prevalent in adults treated with antipsychotic drugs and correlates with markers of intraabdominal adiposity and insulin resistance.

A retrospective analysis of cannabis use in a cohort of mentally ill patients in Sri Lanka and its implications on policy development

BackgroundSeveral epidemiological studies have shown that cannabis; the most widely used illegal drug in the world, is associated with schizophrenia spectrum disorders (SSD).AimsTo assess the characteristics of cannabis use and its association with SSD in a cohort of psychiatrically ill patients and discuss the implications for policy developmentMethodsThis is a retrospective analytical study of a cohort of psychiatric patients who received treatment in the psychiatry unit of the Provincial General Hospital, Ratnapura, Sri Lanka over five years (2000 - 2004). The schizophrenia spectrum disorders defined in this article include schizophrenia and the schizoaffective disorders.ResultsA total of 3644 patient records were analyzed. The percentage of self reported life time cannabis (LTC) use was 2.83% (103, all males). Sixteen percent (576) of the total cohort was diagnosed with SSD by 2009. Male sex and LTC use were significantly associated with SSD (p < 0.01 and 0.001 respectively). In the majority (91.5%), cannabis use preceded the diagnosis. There were 17(16.5%) patients diagnosed as cannabis induced psychosis and 7 (41.2%) of them were subsequently diagnosed as SSD. This group was significantly more likely to have had a past psychiatric consultation, but other demographic and clinical correlates did not differ from the rest of the LTC users.ConclusionsSelf reported LTC use was strongly associated with being diagnosed with SSD. However we could not identify a particular subgroup of users that are at increased risk to recommend targeted primary prophylaxis. The policy implications of this observation are discussed.

No Human Tryptophan Hydroxylase-2 Gene R441H Mutation in a Large Cohort of Psychiatric Patients and Control Subjects

It was recently reported that a rare functional variant, R441H, in the human tryptophan hydroxylase-2 gene (hTPH2) could represent an important risk factor for unipolar major depression (UP) since it was originally found in 10% of UP patients (vs. 1.4% in control subjects). We explored the occurrence of this variation in patients with affective disorders (n = 646), autism spectrum disorders (n = 224), and obsessive-compulsive disorder (OCD) (n = 201); in healthy volunteers with no psychiatric disorders (n = 246); and in an ethnic panel of control individuals from North Africa, Sub-Saharan Africa, India, China, and Sweden (n = 277). Surprisingly, we did not observe the R441H variant in any of the individuals screened (3188 independent chromosomes). Our results do not confirm the role of the R441H mutation of the hTPH2 gene in the susceptibility to UP. The absence of the variant from a large cohort of psychiatric patients and control subjects suggests that the findings reported in the original study could be due to a genotyping error or to stratification of the initial population reported. Additional data by other groups should contribute to the clarification of the discrepancy between our results and those previous published.

Characteristics of a nationwide cohort of psychiatric patients--with special reference to the elderly and the chronically admitted.

The pattern of psychiatric care has changed over the last decades with an extension of outpatient facilities, a decrease in the number of chronically admitted and an increase in the number of shortlasting admissions. A cohort of first time admitted psychiatric patients to Danish institutions in 1970 was followed for 10 years with the purpose to describe the characteristics of the population with multiple admissions. The cohort comprised 12737 patients with 35497 admissions. It was divided into 3 groups, one - 6470 patients - consisting of those with 1 admission, one - 744 - consisting of those continuously admitted to the termination of the study period or their death, and one - 5523 - consisting of those with several admissions. Patients chronically admitted tended to be older, and among them the senile and cerebrovascular disorders were dominating with the non-organic disorders in total comprising less than 10% of the patients. Significantly more females than males were admitted for more than 5 years. Patients with multiple admissions had in total shorter admission periods than the chronically admitted. Males had significantly more admissions than females and 8.2% compared with 3.9% of females had 10 admissions or more.

Assessing the service needs of the discharged psychiatric patient.

In recent years the chronically mentally ill have come to be regarded as a heterogeneous population with a diversity and multiplicity of needs. Social workers assessed a cohort of psychiatric patients being discharged from two state hospitals in terms of their postdischarge service needs. The findings confirmed that these patients needed not only basic mental health services of chemotherapy and counseling but also social rehabilitative services and specialized services such as substance abuse counseling. The data have been utilized by agencies and state and county governmental entities to document the need for new programs and to reorder service priorities. To start a planning process, recommendations on the study findings are being distributed to mental health and human service agencies and family coalitions on a communitywide basis.