Persons with Psychiatric Illnesses Die Prematurely
Medical conditions cause premature deaths in people with mental illness.
It has been known for some time that people who suffer from psychiatric
illnesses die earlier than those without mental illness. According to a
recent large study published in the British Medical Journal by David
Lawrence and colleagues, persons with psychiatric illness die an average
of 14 years earlier than those without such illnesses. This research
group also found that this gap in life expectancy has been increasing
over the last 25 years.
Almost 80% of excess deaths resulted from
physical (medical) conditions. Heart disease and stroke accounted for
about 30% of premature deaths, while cancer resulted in another 14%.
Suicides were responsible for 14%, and accidents, injuries, and violent
deaths accounted for 9%.
One might think that shorter life
expectancies for persons with mental illness pertain only to individuals
with severe illnesses like schizophrenia, bipolar disorder,
or drug addictions. Although alcohol/drug addictions and psychotic
disorders were associated with the greatest decreases in life
expectancy, this study demonstrated that people with non-psychotic
illnesses, including depressive disorders
and “neurotic” disorders, also died prematurely. (Neurotic disorders
include anxiety disorders, certain subtypes of depressive disorders,
phobias, somatoform disorders, and more.)
As mentioned previously, suicide
accounted for about 14% of excess deaths in this study. However, this
percentage varied with specific psychiatric disorders. For example,
suicide accounted for 20% of excess deaths in persons with
schizophrenia, 23% in persons with depressive disorder, and a dramatic
46% of those with affective psychosis, including bipolar disorder.
Affective psychosis is a severe form of mood disorder that typically includes delusions (fixed false beliefs) and/or hallucinations. Why do persons with psychiatric disorders die prematurely from medical causes? The authors of the article suggest several potential factors. The use of cigarettes and abused drugs (including alcohol) is common in persons with psychiatric disorders, and cigarettes and alcohol both increase the risk for heart disease and cancer. Also, psychiatrically ill persons often do not seek or receive healthcare as readily as those without psychiatric illnesses. They also may not comply with recommended treatments and follow up. Some psychiatric medications can result in increased body weight, increased body lipids, and increased blood sugar levels, which are all components of the “metabolic syndrome.” Untreated, the metabolic syndrome can lead to cardiovascular and cerebrovascular illnesses. Finally, certain psychiatric illnesses are associated with lower socioeconomic status (SES), and poorer health outcomes are linked to low SES. Other variables, including more sedentary lifestyles, may also contribute.
A lot can be done to help persons with psychiatric disorders. Mental health professionals must be aware that persons with these disorders have a substantially increased risk for unrecognized or poorly treated physical illnesses. All healthcare professionals should encourage patients to pay attention to lifestyle factors, such as exercise, healthy eating habits, and sleep hygiene, and encourage the avoidance of smoking, abused drugs, and excessive alcohol consumption.
As prejudice against mental illness diminishes, it is important that persons afflicted with these disorders receive better health care and the support necessary for living longer and more productive lives.
E ora spazio ai dubbi.
Ci si chiede cosa sia successo negli ultimi 25 anni, visto l'incremento di morti che questa ricerca avrebbe rilevato. Vengono citate una serie di cause, che passano dal fumo, all'abuso di alcol, all'utilizzo di droghe - quasi questi fossero solo problemi dei "malati" psichiatrici. Ciò che non viene minimamente considerata dagli autori, neanche per essere smentita, è la possibilità che i farmaci psichiatrici e i loro effetti abbiano potuto incrementare la percentuale di decessi. Strano direi, visto che circa 25 anni fa la diagnosi di "depressione" ha avuto una vera e propria esplosione di casi, in concomitanza con l'invenzione di nuovi farmaci SSRI. E questi farmaci hanno vari effetti secondari: il prozac, ad esempio, raddoppia il rischio di suicidio nei pazienti sotto i 24 anni.
In realtà la ricerca prende in considerazione l'effetto dei farmaci ("Some psychiatric medications can result in increased body weight, increased body lipids, and increased blood sugar levels, which are all components of the “metabolic syndrome"), ma per scpecificare subito dopo che il problema non è creato dagli stessi, ma dalla mancata cura degli effetti secondari ("Untreated, the metabolic syndrome can lead to cardiovascular and cerebrovascular illnesses"). Quindi, i problemi cardiovascolari non sarebbero causati dal farmaco, ma dal mancato trattamento della sindrome metabolica, causata dal farmaco stesso.
Altre probabili cause sarebbero uno stile di vita sedentario e la condizione di povertà.
L'articolo si chiude con un invito verso i medici ad incoraggiare degli stili di vita salutari nei propri pazienti. Su questo punto sono pienamente d'accordo: il primo passo potrebbe essere abbandonare l'utilizzo di certi farmaci...
Veronika
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