In my last blog post, I talked about the shameful way that many with schizophrenia are treated (or not treated) for their other co-existing medical problems, like diabetes. There is ample evidence that this lack of proper medical treatment and the failure to exercise preventative measures for conditions like cardiovascular disease results in a shortened life span.
The latest research just released from California show that women with serious mental illnesses are not routinely screened for cervical cancer compared to women without mental illness.
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Despite the weight of all this evidence, the common belief among the anti-psychiatry, anti-medication group is that this reduced life expectancy for those with serious mental illness is the result of the medication they are given. That was one of the comments on my previous blog and it is the opinion of journalist Robert Whitaker of Mad in America fame.
The question we should be asking is what is mortality for those who do not take anti-psychotic medication, which is the standard starting treatment for people diagnosed with schizophrenia. If anti-psychotics are responsible for the shortened life span, then not taking them when diagnosed should result in less mortality. The answer to that can be found in one commentary published this month, in the Lancet, and a study published in Schizophrenia Bulletin. Mortality is quite a bit higher in those not properly treated with anti-psychotics than in those properly treated.
In the British Journal, the Lancet, author Cherrie Ann Galletly states that "Mortality in patients with schizophrenia seems to be highest among those who do not take antipsychotic drugs." The shocking extent of that mortality was demonstrated in a new U.S. study that just appeared in Schizophrenia Bulletin.
Those who died in the 12-month period received the least amount of outpatient care.
Michael Schoenbaum and colleagues examined the long-term patterns of treatment for those with health insurance in the U.S. aged 16-30 receiving a first observed diagnosis of psychosis in 2008-09. They limited their sample to only those with health insurance because, sadly, not having health insurance is itself a barrier in the U.S. to receiving proper medical care. Those identified for the study were followed for a year to find information on mortality, treatment and health resource utilization.
They found 154,322 people with psychotic illnesses. However, they limited their study to only those with a psychotic diagnosis while aged 16-30, continuous insurance coverage for the 12 months prior to diagnosis and 12 months after and a second psychosis diagnosis. This group comprised 1357 people. The second group was made up of 5488 people who had insurance at the time of diagnosis, but not for a year before and after and had only the one diagnosis.
Almost two-thirds of the people (61 per cent) did not fill their prescriptions for anti-psychotics in the year after diagnosis and 41 per cent did not receive any psychotherapy. Mortality for this group was anywhere between 24 times to 89 times greater than comparable for those aged 16-30 in the general U.S. population. The authors commented that "in the general population, only individuals over 70 years of age have all-cause mortality approaching the rate we observed among young psychosis patients here."
The study also found that there was very little medical oversight of these patients and only "modest" psychosocial treatment. Those who died in the 12-month period received the least amount of outpatient care.
Premature death for those with schizophrenia is complex and not as simple as the anti-psychiatry crowd suggests. It results from a combination of poor treatment and preventative care these people receive from the medical system, and the failure to treat their mental illness appropriately and aggressively. In the U.S., it appears to be confounded by the lack of universal health care.
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