Schizophrenia sufferers face harder times
THE harsh reality of living with schizophrenia is becoming bleaker, according to Queensland researchers who have tracked the general health and longevity of people with the debilitating mental disorder.
According to epidemiologist and psychiatrist John McGrath, people living with schizophrenia today are 2.5 times more likely than the general population to die early from all causes of death, not just suicide.
That’s nearly twice the difference between the two populations in the 1960s, says McGrath, with the University of Queensland (UQ) and the Queensland Centre for Mental Health Research (QCMHR).
‘‘ Because of the increased focus on mental health care seen in many countries over the last few decades, you’d predict that the situation would have improved, not worsened,’’ he suggests.
According to McGrath, the fundamental problem was revealed as long ago as 2001 by University of Western Australia neuropsychiatrist Assen Jablensky and his colleagues.
They showed clearly that compared to the general population, people with mental illness received worse health care — or none — for non-psychiatric illness and lifestyle problems such as smoking and alcoholism.
Melbourne-based Jayashri Kulkarni — a biological psychiatrist at the Alfred Psychiatry Research Centre (APRC) at Alfred Hospital — said the Queensland findings highlight the urgent need to improve services for people with schizophrenia.
‘‘ The overall picture is appalling. It shouldn’t be tolerated in this day and age,’’ says Kulkarni, who specialises in schizophrenia and women’s mental health.
The disturbing news comes from a review of 37 reports from 25 nations — wealthy and poor — which McGrath and his UQ and QCMHR colleagues published this week in the Archives of General Psychiatry (2007;64(10):1-9).
According to Professor McGrath, the worsening mortality rate for people with schizophrenia is brought into focus by the simultaneous drop in early death among the general population.
‘‘ The general community is doing well but our patients (with schizophrenia) are lagging behind. It’s not good. It’s an outcome that makes you worry,’’ he says.
Worse, the new medications could well make this situation even worse in the next few decades, McGrath predicts.
That’s because while new antipsychotic drugs such as clozapine and olanzapine — soldin Australia as Clopine and Zyprexa — treat the delusions and hallucinations triggered by schizophrenia better than the firstgeneration of medications, they can cause weight gain and other metabolic disorders.
Over time such conditions contribute to diabetes, cardiovascular disease and other disorders that, if untreated, may lead to serious disease and premature death.
McGrath says the new medications haven’t been available long enough to have caused those diseases in people taking them, so early deaths are not yet appearing in the statistics. ‘‘ There’s a lag,’’ he says. ‘‘ We’re worried the second generation (of antipsychotics) hasn’t kicked in.’’
Psychiatrist and researcher Paul Fitzgerald, APRC deputy director, is less convinced that the new drugs are worsening early death.
That’s so, he says, because it’s been longknown that people with schizophrenia suffer early death and receive poorer quality health care than the rest of the population.
‘‘ The significance is that (the work) hammers home the need for a whole-ofhealth approach (for people with schizophrenia) that’s not just drugs.
‘ It also provides a strong argument for a research approach that relooks at the causes of schizophrenia with the purpose that it might lead to identifying mechanisms that might lead to new drugs that have improved psychological benefits but reduce side effects such as weight gain,’’ said Fitzgerald.
He said that announcements from both sides of politics this week for more services for autism reflected an ongoing problem with development of improved treatments for mental disorders.
‘‘ They again completely ignored the need for research as part of the agenda,’’ he said. ‘‘ There’s no question that there should be better services for these people. But it’s also unquestioned that we can’t improve the services and treatments unless we do the research that will provide better treatments.’’