Schizophre­nia suf­fer­ers face harder times

The Weekend Australian - Travel - - Health - Leigh Day­ton Science Writer

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.’’

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.