Early recognition and treatment of coronary artery disease must become a clinical priority for all adults with schizophrenia, say researchers who studied autopsy data for schizophrenia patients who died suddenly in hospital.
Peter Manu (Zucker Hillside Hospital, Glen Oaks, New York, USA) and colleagues reviewed the medical records of 7189 schizophrenia patients admitted to a public, psychiatric teaching hospital in Romania from 1989 to 2013. Of these, 57 (0.8%) died suddenly and unexpectedly.
Autopsies were performed in 51 (89.5%) patients (mean age 56 years, 57% men) and showed that cardiovascular disorders were the most common cause of sudden death, occurring in 62.8% of cases.
These included 27 (52.9%) patients with acute myocardial infarction, three (5.9%) with myocarditis, one (2.0%) with dilated cardiomyopathy and one (2.0%) with haemopericardium.
Manu and team note that the patients with and without myocardial infarction did not differ significantly in terms of age, gender, smoking, body mass index or psychotropic treatment.
They add that the rate of myocardial infarction they identified was “greater than that in community samples and, if confirmed in [larger] samples of patients with schizophrenia, may represent a specific vulnerability of patients with this psychotic disorder.”
Eleven (21.6%) patients died of a respiratory disorder, including six (11.8%) cases of pneumonia, four (7.8%) airway obstructions (laryngeal or tracheal) with food boluses, and one (2.0%) massive pulmonary embolus.
There were two (3.9%) deaths caused by a neurological disorder – one haemorrhagic stroke and one brain tumour – and in six cases (11.8%) the post-mortem macroscopic and histological examination did not identify a specific cause of death. However, extensive coronary arteriosclerosis was identified in three of these patients, and dystrophic myocardial changes and chronic pericarditis occurred in one patient each.
Despite a higher rate of sudden death overall, the researchers say that their findings support the hypothesis that the causes of sudden death in schizophrenia do not differ from those observed in community-dwelling populations and in patients admitted to general hospitals without severe mental illness.
Writing in Schizophrenia Research, the team concludes that reducing the rate of sudden death “will require not only early detection and treatment of coronary and diabetogenic risk factors in psychiatric settings, but also parity in access and quality of medical care for patients with schizophrenia.
“In order to achieve these important goals that have been highlighted for at least a decade now, provider, patient and system level barriers must be identified and addressed.”
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