Medical Comorbidity in Elderly Schizophrenic Patients: A Preliminary Study in Iran

Author(s): Saeed Shoja Shafti*, Alireza Memarie, Masomeh Rezaie, Behjat Rahimi

Journal Name: Current Psychiatry Research and Reviews
Formerly Current Psychiatry Reviews

Volume 16 , Issue 2 , 2020


Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Abstract:

Background: While comorbidity between mental disorders and physical illnesses is the rule rather than an exception, appraising the impact of comorbidity is challenging due to lack of consensus about how to define and measure the concept of comorbidity.

Objective: The aim of the present evaluation was to appraise the prevalence and features of medical comorbidities among a group of native elderly schizophrenic patients.

Methods: Geriatric unit of Razi psychiatric hospital was selected as the field of investigation and 168 elderly schizophrenic patients (≥65 years old), including 101 males and 67 females, who have been hospitalized there as chronic cases, were chosen as an accessible sample, and were surveyed with respect to existing comorbid medical disorders. Psychiatric diagnosis was based on ‘Diagnostic and Statistical Manual of Mental Disorders’, 5th edition (DSM-5), and the medical diagnosis was based on ‘International Classification of Diseases’, 10th edition.

Results: As shown by the results, 89% (n=151) of elderly schizophrenic patients had some kind of registered physical co-morbidity, which was more significant than the frequency of medical comorbidities among native senior citizens. Amongst the listed co-morbidities, falls, hypertension and osteoarthritis were the most prevalent comorbidities with a frequency of around 48.8%, 44.6% and 39.2%, respectively. Hypertension, renal disease and malnutrition were significantly more prevalent among male patients (p<0.0000, p<0.0045 and p< 0.0018, respectively) and hyponatremia, aspiration/ asphyxiation and seizure were meaningfully more prevalent among female patients (p<0.0075, p<0.0000 and p<0.0009, respectively). As stated by the findings and in comparison with the native seniors, while diabetes, renal diseases and malnutrition were significantly more frequent, coronary artery disease, gastrointestinal disorder and osteoarthritis were significantly less frequent in the existing sample of elderly schizophrenic patients.

Conclusion: In comparison with the native senior people, the rate of medical comorbidities, particularly diabetes, renal diseases and malnutrition, was significantly higher in elderly schizophrenic patients, a significant difference, was observed regarding physical comorbidities between male and female patients, which demands further methodical and gender-based studies for defining more appropriate care.

Keywords: Schizophrenia, psychiatric disorders, medical comorbidity, elderly mental patients, senior persons, chronic patients.

[1]
Šprah L, Dernovšek MZ, Wahlbeck K, Haaramo P. Psychiatric readmissions and their association with physical comorbidity: a systematic literature review. BMC Psychiatry 2017; 17(1): 2.
[http://dx.doi.org/10.1186/s12888-016-1172-3] [PMID: 28049441]
[2]
Cloninger RC. Implications of Comorbidity for the Classification of Mental Disorders: The Need for a Psychobiology of Coherence. In: López-Ibor JJ, Maj M, Sartorius N, Gaebel W, Eds. Psychiatric Diagnosis and Classification. West Sussex: Wiley 2002; pp. 79-106.
[http://dx.doi.org/10.1002/047084647X.ch4]
[3]
AIHW (Australian Institute of Health and Welfare). Comorbidity of mental disorders and physical conditions, Cat no PHE 155. Canberra: AIHW 2007.
[4]
Egede LE. Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry 2007; 29(5): 409-16.
[http://dx.doi.org/10.1016/j.genhosppsych.2007.06.002] [PMID: 17888807]
[5]
Andrés E, García-Campayo J, Magán P, et al. Psychiatric morbidity as a risk factor for hospital readmission for acute myocardial infarction: an 8-year follow-up study in Spain. Int J Psychiatry Med 2012; 44(1): 63-75.
[http://dx.doi.org/10.2190/PM.44.1.e] [PMID: 23356094]
[6]
Jakovljević M, Ostojić L. Comorbidity and multimorbidity in medicine today: challenges and opportunities for bringing separated branches of medicine closer to each other. Psychiatr Danub 2013; 25(Suppl. 1): 18-28.
[PMID: 23806971]
[7]
Vigod SN, Taylor VH, Fung K, Kurdyak PA. Within-hospital readmission: an indicator of readmission after discharge from psychiatric hospitalization. Can J Psychiatry 2013; 58(8): 476-81.
[http://dx.doi.org/10.1177/070674371305800806] [PMID: 23972109]
[8]
Kessing LV, Nilsson FM, Siersma V, Andersen PK. Increased risk of developing diabetes in depressive and bipolar disorders? J Psychiatr Res 2004; 38(4): 395-402.
[http://dx.doi.org/10.1016/j.jpsychires.2003.12.001] [PMID: 15203291]
[9]
Morrow-Howell NL, Proctor EK, Blinne WR, Rubin EH, Saunders JA, Rozario PA. Post-acute dispositions of older adults hospitalized for depression. Aging Ment Health 2006; 10(4): 352-61.
[http://dx.doi.org/10.1080/13607860500409963] [PMID: 16798627]
[10]
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36(1): 8-27.
[http://dx.doi.org/10.1097/00005650-199801000-00004] [PMID: 9431328]
[11]
De Hert M, Cohen D, Bobes J, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011; 10(2): 138-51.
[http://dx.doi.org/10.1002/j.2051-5545.2011.tb00036.x] [PMID: 21633691]
[12]
Brown S, Kim M, Mitchell C, Inskip H. Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry 2010; 196(2): 116-21.
[http://dx.doi.org/10.1192/bjp.bp.109.067512] [PMID: 20118455]
[13]
Laursen TM, Munk-Olsen T, Agerbo E, Gasse C, Mortensen PB. Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry 2009; 66(7): 713-20.
[http://dx.doi.org/10.1001/archgenpsychiatry.2009.61] [PMID: 19581562]
[14]
Tosh G, Clifton A, Mala S, Bachner M. Physical health care monitoring for people with serious mental illness. Cochrane Database Syst Rev 2010; (3): CD008298
[PMID: 20238365]
[15]
Harvey PD, Czaja SJ, Loewenstein DA. Schizophrenia in later life. Am J Geriatr Psychiatry 2012; 20(1): 1-4.
[http://dx.doi.org/10.1097/JGP.0b013e31823bbf93] [PMID: 22104378]
[16]
Dickens J, Boustani MA, Callahan CM. Comorbidity profile and health care utilization in elderly patients with serious mental illnesses. Am J Geriatr Psychiatry 2013; 21: 1-14.
[17]
Hendrie HC, Lindgren D, Hay DP, et al. Comorbidity profile and healthcare utilization in elderly patients with serious mental illnesses. Am J Geriatr Psychiatry 2013; 21(12): 1267-76.
[http://dx.doi.org/10.1016/j.jagp.2013.01.056] [PMID: 24206938]
[18]
Himelhoch S, Weller WE, Wu AW, Anderson GF, Cooper LA. Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Med Care 2004; 42(6): 512-21.
[http://dx.doi.org/10.1097/01.mlr.0000127998.89246.ef] [PMID: 15167319]
[19]
Prince JD, Akincigil A, Kalay E, et al. Psychiatric rehospitalization among elderly persons in the United States. Psychiatr Serv 2008; 59(9): 1038-45.
[http://dx.doi.org/10.1176/ps.2008.59.9.1038] [PMID: 18757598]
[20]
Chwastiak LA, Davydow DS, McKibbin CL, et al. The effect of serious mental illness on the risk of rehospitalization among patients with diabetes. Psychosomatics 2014; 55(2): 134-43.
[http://dx.doi.org/10.1016/j.psym.2013.08.012] [PMID: 24367898]
[21]
Bennett KJ, Probst JC, Vyavaharkar M, Glover S. Missing the handoff: post-hospitalization follow-up care among rural Medicare beneficiaries with diabetes. Rural Remote Health 2012; 12: 2097.
[PMID: 22816373]
[22]
Garrison GM, Mansukhani MP, Bohn B. Predictors of thirty-day readmission among hospitalized family medicine patients. J Am Board Fam Med 2013; 26(1): 71-7.
[http://dx.doi.org/10.3122/jabfm.2013.01.120107] [PMID: 23288283]
[23]
Calvillo-King L, Arnold D, Eubank KJ, et al. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med 2013; 28(2): 269-82.
[http://dx.doi.org/10.1007/s11606-012-2235-x] [PMID: 23054925]
[24]
Himelhoch S, Leith J, Goldberg R, Kreyenbuhl J, Medoff D, Dixon L. Care and management of cardiovascular risk factors among individuals with schizophrenia and type 2 diabetes who smoke. Gen Hosp Psychiatry 2009; 31(1): 30-2.
[http://dx.doi.org/10.1016/j.genhosppsych.2008.07.007] [PMID: 19134507]
[25]
Daumit GL, Pronovost PJ, Anthony CB, Guallar E, Steinwachs DM, Ford DE. Adverse events during medical and surgical hospitalizations for persons with schizophrenia. Arch Gen Psychiatry 2006; 63(3): 267-72.
[http://dx.doi.org/10.1001/archpsyc.63.3.267] [PMID: 16520431]
[26]
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association 2013.
[27]
World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva: World Health Organization 2011.
[28]
Tootoonchi P. Chronic diseases and senile changes in the elderly population. Payesh 2004; 3: 219-25.
[29]
Wallace M. Essentials of Gerontological Nursing. New York: Springer Publishing Company, LLC 2008; pp. 145-74.
[30]
Zubenko GS, Mulsant BH, Sweet RA, Pasternak RE, Tu XM. Mortality of elderly patients with psychiatric disorders. Am J Psychiatry 1997; 154(10): 1360-8.
[http://dx.doi.org/10.1176/ajp.154.10.1360] [PMID: 9326817]
[31]
Zgueb Y, Jomli R, Ouertani A, et al. Deaths in a Tunisian psychiatric hospital: an eleven-year retrospective study. Encephale 2014; 40(5): 416-22.
[http://dx.doi.org/10.1016/j.encep.2014.07.007] [PMID: 25132014]
[32]
Räsänen S, Hakko H, Viilo K, Meyer-Rochow VB, Moring J. Excess mortality among long-stay psychiatric patients in Northern Finland. Soc Psychiatry Psychiatr Epidemiol 2003; 38(6): 297-304.
[http://dx.doi.org/10.1007/s00127-003-0635-2] [PMID: 12799779]
[33]
Gausset MF, Casadebaig F, Guillaud-Bataille JM, Quemada N, Terra JL. Mortality of mentally ill patients. Review of the literature. Encephale 1992; 18(1): 93-100.
[PMID: 1600896]
[34]
Lim LC, Sim LP, Chiam PC. Mortality among psychiatric inpatients in Singapore. Singapore Med J 1991; 32(3): 130-2.
[PMID: 1876881]
[35]
Hewer W, Rössler W. Mortality of patients with functional psychiatric illnesses during inpatient treatment. Fortschr Neurol Psychiatr 1997; 65(4): 171-81.
[http://dx.doi.org/10.1055/s-2007-996320] [PMID: 9235309]
[36]
Tabbane K, Joober R, Spadone C, Poirier MF, Olié JP. Mortality and cause of death in schizophrenia. Review of the literature. Encephale 1993; 19(1): 23-8.
[PMID: 8275890]
[37]
Abiodun OA. Mortality in a psychiatric population: a Nigerian psychiatric hospital experience. Acta Psychiatr Scand 1988; 77(6): 654-7.
[http://dx.doi.org/10.1111/j.1600-0447.1988.tb05184.x] [PMID: 3261482]
[38]
Kamara SG, Peterson PD, Dennis JL. Prevalence of physical illness among psychiatric inpatients who die of natural causes. Psychiatr Serv 1998; 49(6): 788-93.
[http://dx.doi.org/10.1176/ps.49.6.788] [PMID: 9634158]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 2
Year: 2020
Published on: 16 August, 2020
Page: [103 - 109]
Pages: 7
DOI: 10.2174/2666082216666200817104424
Price: $65

Article Metrics

PDF: 21
HTML: 1