By Dr Beenish Memon, Psychiatrist
People with the severe enduring mental illness have a higher mortality as well as morbidity rate as compared to general population. Highest mortality rates are found among patients with schizophrenia, followed by major depression and then BPAD.
Various factors have been linked such as unhealthy lifestyle (heavy smoking, recreational drug use, alcohol abuse, poor nutrition and sedentary lifestyle); inadequate physical healthcare but the potential impact of psychotropic medications on mortality risk has always been the subject of intense debate.
While antipsychotics have potential to adversely affect physical health (obesity, diabetes, and hyperlipidemia), it is important to note that there have been several studies which have suggested that all-cause mortality is higher in patients with schizophrenia not receiving antipsychotics (Torniainen et al., 2014; Tiihonen et al., 2009).
Additionally, heavy smoking, recreational drug use, alcohol abuse, poor nutrition and sedentary lifestyle in a population diagnosed with the psychiatric disease are associated with increased mortality risk. There is a possibility that there are other intrinsic factors to psychiatric illness which might be contributing to excess mortality (Fran, 2016).
We have to be mindful that Psychiatric patients are less likely to talk effectively about their medical problems especially when they are mentally unwell. Once a patient is commenced on psychotropic medication, specific medication side effects are monitored via regular physical health check. This contributes to improving physical and well as mental health outcomes. Patients who are left untreated are at high risk of disengaging not only with mental health but physical health services as well. They are more at risk of using alcohol and drugs to cope with their symptoms. Thus, at increased risk for morbidity and mortality.
Moreover, there is evidence to suggest that some psychotropic such as clozapine, antidepressants, and lithium are associated with reduced mortality from suicide.
We have to understand that patients with Severe Mental Illness need psychotropic medication in addition to psychosocial intervention to improve their mental health and prevent relapse. Hence, the potential risks of antipsychotics, antidepressants, and mood stabilizers need to be weighed against the risk of the psychiatric disorders for which they are used and the lasting potential benefits that these medications can produce.
Despite the fact that psychiatric patient carries a high risk of mortality and morbidity, The medical care of physical disorders provided to psychiatric patients is less adequate than for the population in general (Björkenstam et al., 2012). They are not vigilantly monitored by primary care services for early detection and intervention of medical conditions.
Finally, I feel psychotropic medications not only improve the mental health of patients they improve their engagement with medical care and will significantly reduce mortality if this patient group is provided with best possible medical care. The entire blame of increase mortality cannot be attributed to the adverse effects of psychotropic medications because these effects should be proactively and vigilantly monitored and treated by a joint effort from psychiatric and primary care services. Furthermore, 50% to 80% of people with Severe Mental Illness smoke tobacco, an important reversible risk factor for cardiovascular disease. If we look into providing this patient group with better physical health care provisions and encouraging them into adopting a healthier lifestyle we can significantly reduce the mortality rate.
Cite this article as:
Beenish Memon (2016)Are psychotropic medications associated with increased risk of mortality.The Beautiful Space-A Journal of Mind, Art and Poetry. November 2016: TBSB106
Björkenstam, E., Ljung, R., Burström, B., Mittendorfer-Rutz, E., Hallqvist, J. and Weitoft, G. (2012). The quality of medical care and excess mortality in psychiatric patients—a nationwide register-based study in Sweden. BMJ Open, 2(1), p.e000778.
Fran, L. (2016). Psychotropics Lower, Don't Raise, Mortality in Psych Patients. [online] Medscape. Available at: http://www.medscape.com/viewarticle/810209 [Accessed 19 Oct. 2016].
Khan, A., Faucett, J., Morrison, S. and Brown, W. (2013). Comparative Mortality Risk in Adult Patients With Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, and Attention-Deficit/Hyperactivity Disorder Participating in Psychopharmacology Clinical Trials. JAMA Psychiatry, 70(10), p.1091.
Tiihonen, J., Lönnqvist, J., Wahlbeck, K., Klaukka, T., Niskanen, L., Tanskanen, A. and Haukka, J. (2009). 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). The Lancet, 374(9690), pp.620-627.
Torniainen, M., Mittendorfer-Rutz, E., Tanskanen, A., Bjorkenstam, C., Suvisaari, J., Alexanderson, K. and Tiihonen, J. (2014). Antipsychotic Treatment and Mortality in Schizophrenia. Schizophrenia Bulletin, 41(3), pp.656-663.
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