Smoking cessation a priority in schizophrenia
medwireNews: Smoking is a major driver of death by natural causes among patients with schizophrenia, report researchers.
“These findings underscore the life-shortening effects of smoking in this population and the urgent need to more vigorously promote smoking cessation,” write study author Faith Dickerson (Sheppard Pratt Health System, Baltimore, Maryland, USA) and team in Schizophrenia Research.
They found that schizophrenia patients were 4.7 times more likely to die during follow-up averaging 6.2 years if they smoked, after accounting for age and gender.
Of 517 patients in the study, six died of unnatural causes and 25 died of natural causes, primarily cardiovascular. Other natural causes were respiratory, neoplastic, infectious, blood disease, and mental (delirium, in one patient).
Evidence of exposure to infectious agents was also associated with mortality, with the presence of antibodies to Epstein–Barr virus (EBV) and to Herpes Simplex virus type 1 (HSV-1) being associated with 1.13- and 1.22-fold risk increases, respectively.
The researchers say that the association with HSV-1 infection is a novel finding, and speculate that it could be related to cognitive function; they previously found a “robust” association between HSV-1 and cognitive functioning in schizophrenia – a factor that they did not adjust for in the current study.
Latent EBV infection, on the other hand, could be reactivated and have an adverse affect on patients with compromised immune function, they suggest. Immunologic conditions were present in 20.0% of patients who died versus 4.7% of those who did not, and raised mortality risk a significant 4.5-fold. The most common immunologic condition was insulin-dependent diabetes, being present in 16 of 33 patients with such conditions.
Cardiovascular conditions were most prevalent in survivors as well as in patients who died, and were associated with a 2.5-fold increased mortality risk. Also, genitourinary conditions, most commonly urinary tract infection, were present in 32.0% of patients who died, compared with 8.6% of those who survived, equating to a 4.35-fold increased mortality risk.
“It is of note that urinary tract infections have been found to be highly prevalent in persons with acute psychotic symptoms,” the team observes.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Eleanor McDermid, Senior medwireNews Reporter