New research shows that individuals with schizophrenia are significantly more likely to live longer if they take their antipsychotic drugs on schedule, avoid extremely high doses and also regularly see a mental health professional.
Psychiatrists have long known that people with schizophrenia who stick to a drug regimen have fewer of the debilitating delusions and hallucinations that are hallmarks of this illness, say researchers at Johns Hopkins University.
But there are concerns about possible side effects of the medications, including increased risk of cardiovascular disease and diabetes, the researchers note.
“We know that antipsychotic medications reduce symptoms, and our study shows that staying on reasonable, recommended doses is associated with longer life,” said Dr. Bernadette A. Cullen, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, and leader of the study published in Schizophrenia Bulletin. “The same is true for going to see a psychiatrist or therapist.”
She added that regular visits to a mental health professional are one way to monitor and encourage drug-use compliance, but the visits themselves also increased survival in this vulnerable population.
Cullen and her colleagues analyzed data collected between 1994 through 2004 on 2,132 adult Maryland Medicaid beneficiaries with schizophrenia. The researchers reviewed how much medication the patients took, how regularly they took it, and how often they visited a mental health professional.
The researchers found that among those patients who had 90 percent or better compliance with their medication schedules, the risk of death was 25 percent lower compared to those who were less than 10 percent compliant.
Over the decade-long study period, taking medication did not increase the risk of death and there was a trend towards reducing the mortality rate, the researchers found. They also found that each additional visit per year to a mental health professional was linked to a 5 percent reduction in risk of death overall.
The study did not rule out all links between increased mortality and antipsychotic drugs. For example, her team found that people who took high doses of first-generation antipsychotic medication daily (1500 mg or greater chlorpromazine equivalents) were 88 percent more likely to die.
She said mortality rates possibly increased in this group because first-generation antipsychotics have been associated with cardiac disease risks, and among those who died while taking the larger doses, 53 percent died of cardiovascular disease.
“These drugs work very well, but there is clearly a point of diminishing returns,” she said. “You rarely need to be on extremely high doses.”
The most common cause of death was cardiovascular disease (28 percent); while unintended harm, including suicide, was responsible for 8 percent.
“If people are taking their medications, they usually have fewer symptoms and are able to be more organized in other areas of their lives,” said Cullen. “We believe they are then more likely to make appointments with their primary care doctors, to stay on top of other illnesses they may have and to regularly take diabetes, blood pressure or cholesterol medication that they may require to stay healthy.
“We also believe that they are more likely to be socially engaged and have a healthier lifestyle. If your illness is under control, you can do a lot more.”
The study clearly lays out the value of mental health providers to individuals with schizophrenia. Those who saw therapists or psychiatrists were more likely to survive, regardless of whether the individual also took his or her antipsychotic medication on a regular basis, Cullen said.
This is important because Maryland Medicaid officials are considering capping the number of mental health visits allowed each year, something the data now suggest is potentially detrimental to survival.
Source: Johns Hopkins Medicine