Psychiatric Disorders Linked to More Physical Disease
In an article in the journal JAMA Network Open, Leah S. Richmond-Rakerd and colleagues found that people with mental disorders had more physical disease at younger ages, they had more and longer hospitalizations and associated health care costs, and they were more likely to die at younger ages than people without mental disorders.
The research came from a population-based cohort study of more than 2.3 million citizens of New Zealand over three decades. The authors concluded, “These findings suggest that ameliorating mental disorders may have implications for improving the length and quality of life and for reducing the health care costs associated with physical diseases.”
Editor’s Note: This editor would suggest the importance of also doing the opposite, that is, looking out for and treating and preventing the physical illnesses to which psychiatric patients are more vulnerable in order to improve the length and quality of life.
Either way, medical illnesses, both physical and psychiatric, are intimately intertwined, and both deserve careful and early intervention. Psychiatric and physical illnesses cause suffering, disability, and early demise. Major psychiatric illnesses need to be seen as potentially lethal medical illnesses, a fact that few people realize. Conversely, physical illnesses are often not treated as aggressively or intensively in psychiatric patients as in the general population. For example, patients with bipolar disorder get fewer interventions with stents and bypasses for the same heart problems as others. Special attention needs to be given to better encourage and support the medical health of psychiatric patients.
Adherence to Antidepressants Associated with Lower Mortality
A large study from Israel suggests that over a 4-year period, people who regularly took their prescribed antidepressants were less likely to die of any cause during that period.
The study, published in the Journal of Clinical Psychiatry in 2016, used data from an Israeli health provider that covers 53% of the nation’s population. It included 251,745 patients aged 40 and up who filled a prescription for an antidepressant at least once between 2008 and 2011.
Researchers led by Amir Krivoy looked at how much of the time people actually filled their prescriptions. Patients who filled their prescriptions more of the time were less likely to die during the study period than those who did not fill their prescriptions regularly.
Editor’s Note: This study by Krivoy and colleagues provides more evidence of the benefit of long-term antidepressants. People who have had two or three episodes of unipolar depression should consider long-term prevention with antidepressants over the course of their lifetime, in the way that people take blood pressure medications long-term to prevent heart attacks. In addition to lowering mortality, antidepressants also reduce the rate of relapse by 75% compared to placebo. More time on antidepressants also preserves hippocampal volume with aging.
Eat More Plants for Health
A long-term study of 130,000 nurses and other health professionals found that eating more plants lowered risk of death over several decades. A 3% increase in calories from plant protein was associated with a 10% lower risk of death during the study period.
The research, by Mingyang Song and colleagues in the journal JAMA Internal Medicine, found that the more animal protein consumed, the higher the risk of death from cardiovascular disease during the study. A 10% increase in the proportion of calories from animal protein was associated with a 2% increase in deaths. This association was worse for people who were obese or heavy drinkers.
Song and colleagues suggest that plants are a better source of calories than are animal products, and that fish or chicken are better choices than processed red meat.
Researcher Dariush Mozaffarian recommends eating plant-based foods like fruits, nuts, seeds, beans, and non-starchy vegetables, but avoiding those like French fries or white bread that have little nutritional value.
Smoking Ban in New Jersey Jails Drastically Reduced Deaths of Inmates with Mental Illness
Policy changes by the New Jersey Department of Corrections drastically reduced the availability of tobacco products in New Jersey jails between 2005 and 2014. Prison commissaries reduced their stock of tobacco, prices increased, sales to minors were banned, and facilities were designated tobacco-free (including for staff and visitors).
Along with this reduction in the availability of tobacco products, the Department of Corrections also introduced smoking cessation programs, began offering nicotine replacement lozenges in commissaries, and increased treatment for tobacco use.
A surprise consequence of the decision to go tobacco-free was a drastic reduction of deaths among prison inmates with mental illness. The mortality rate for these inmates dropped by 48%. In contrast, the mortality rate for inmates without mental illness remained flat before and after the tobacco ban.
People with mental illness are at increased risk of mortality, particularly from cardiovascular illnesses. Now it seems that eliminating tobacco use can go a long way toward improving health and reducing mortality for these people.
Multiple Risks of Benzodiazepine Use
Benzodiazepines are a class of drugs that became widely used in the 1970s for their ability to reduce panic, anxiety, and insomnia. Some also functioned as anticonvulsants, reducing seizures. They are considered “downers,” with sedating qualities.
New research shows that benzodiazepine use, particularly long-term use, comes with risks such as increased mortality and mood instability.
At a 2015 scientific meeting, researcher Jari Tiihonen reported that among 21,492 patients with schizophrenia in Sweden, benzodiazepine use was associated with increased mortality, while antidepressant and antipsychotic use decreased mortality.
At the same meeting, researcher Cristina Albott reported that benzodiazepines may interfere with the rapid onset of antidepressant effects usually brought about by intravenous treatment with the drug ketamine.
In 2010, researcher Roy Perlis reported in the Journal of Clinical Psychiatry that in STEP-BD, a large study of people with bipolar disorder, benzodiazepine use was associated with an increased risk of recurrence of mood episodes.
Editor’s Note: Benzodiazepines can also exacerbate symptoms of post-traumatic stress disorder (PTSD) and regular use can lead to a decrease in lifespan. It now seems as though there are many reasons to exercise caution in the use of these drugs.
Mental Illness Associated with 10 Years Lost Life Expectancy
Severe mental illness is one of the leading causes of death worldwide. Recently researchers led by E.R. Walker performed a meta-analysis of all cohort studies comparing people with mental illness to non-ill populations. They used five databases to find 203 eligible studies from 29 countries. Their findings, published in the journal JAMA Psychiatry in 2015, show that people with mental illness have a mortality rate 2.22 times higher than people without mental illness. People with mental illness lose a potential 10 years of life compared to those without severe mental disorders. The researchers estimated that 14.3% of deaths worldwide are attributable to mental illness.
Editor’s Note: Comorbid cardiovascular illness accounts for a large part of the disparity in life expectancy between people with and without mental illness. Those at risk for serious mental illness should pay close attention to their cardiovascular as well as psychiatric risk factors.
Cynicism Linked to Dementia
A decades-long study called Cardiovascular Risk Factors, Aging and Dementia (CAIDE) observed older participants for signs of dementia, and collected data on participants’ levels of cynical distrust, for example, the belief that others will lie or cheat for personal gain and that it’s safer not to trust anyone.
A 2014 study by Elisa Neuvonen et al. in the journal Neurology reported that after adjusting for demographic and other factors, those participants with the highest levels of cynical distrust of others were at higher risk for dementia as they aged. This relationship was not explained by depressive symptoms. The authors suggest that a positive attitude may protect the brain.
The researchers acknowledge that it is possible the distrust may be a result of brain changes leading to dementia, rather than the cause of it.
Those with the highest levels of cynical distrust were also at higher risk for death, but this association disappeared when the researchers controlled for socioeconomic factors and health behaviors such as smoking.
The researchers hope to investigate whether having a cynical attitude early in life is more robustly linked to mortality. It would be exciting to determine whether a shift to a more positive attitude earlier in life could prevent dementia.
Editor’s Note: A high level of chronic anger is associated with shorter telomeres. Telomeres sit at the end of DNA strands and shorten with each cell replication. Shorter telomeres are linked to multiple medical and psychiatric disorders. It may be that cynical distrust shortens telomeres, and is thus associated with dementia.
