Mental Illness and Mortality

Last night when my brain was car-crashing, I was reading about 10 articles per five minutes. One them was this about serious mental illness and mortality.

That was the article that triggered my panic attack. Here’s another:

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Clinical & Research News

Death Data Have Researchers Searching for Answers Eve Bender

People with serious mental illness are dying at higher rates and at earlier ages than people in the general population who don’t have mental illness.

Metabolic dysfunction caused by some medications may play a role. People with serious mental illness in one sample of psychiatric inpatients had more than three times the rate of death of those in the general population without mental illness and died an average of 32 years earlier.

The leading causes of death among people in the sample, most of whom were diagnosed with a psychotic disorder, were heart disease, suicide, accidents, and cancer.

The findings call for increased screening and monitoring of patients with serious mental illness for medical comorbidities, according to the authors of the study, published in the October Psychiatric Services.

Researchers collected medical information on 20,018 patients hospitalized on at least one occasion at one of nine hospital sites associated with five behavioral health care organizations in Ohio’s public mental health system between 1998 and 2002.

They matched patients’ hospital records with death records from the Ohio Department of Health and identified 608 patients who died during the four-year period (hospital deaths were included in the sample).

The patients who died had been diagnosed with a number of mental disorders, including schizophrenia (134), schizoaffective disorder (128), alcohol abuse (101), bipolar disorder (87), alcohol dependence (85), major depressive disorder (80), cannibis abuse (59), other mixed or unspecified drug abuse (56), and cocaine abuse (35). The majority of patients in the sample died from heart disease (126), suicides (108), accidents (83), or cancer (44).

Researchers also measured years per life lost for those who died, which is a measure of premature death based on the current mean survival age for a cohort matched by age and gender in the general population. Patients with serious mental illness died an average of 32 years earlier than patients in the general population, according to the findings.

The average age of death for the people in the sample was 47.7 years. When researchers calculated the standard mortality ratio for patients in the sample who died, they found 3.2 times the rate of death as that of the general U.S. population.

The most prevalent comorbid medical conditions for patients in the sample who died included obesity (144), hypertension (136), diabetes (70), chronic obstructive pulmonary disease (62), and injuries (39). Among the 126 patients who died of heart disease, leading comorbidities included hypertension, obesity, diabetes, chronic obstructive pulmonary disease, and disorders of lipid metabolism.

Previous research has yielded similar results. For example, a report released by the federal Centers for Disease Control and Prevention in April said that patients with schizophrenia or bipolar disorder lose as much as 20 years off their average life expectancy compared withsimilar individuals in the general population without seriousmental illness and had elevated rates of heart disease (Psychiatric News, July 7).

At a 2004 meeting convened by the American Diabetes Association and attended by several APA members, the organization issued a consensus statement confirming the risk of metabolic changes associated with second-generation anti-psychotics and calling for careful monitoring of patients on these medications.

In the study of hospitalized patients with serious mental illness in Ohio, researchers could not draw conclusions about cause of death. They speculated, however, that underlying factors may have included medication-induced weight gain, poor personal hygiene, reduced physical activity, increased prevalence of smoking and substance use, and inadequate social support, according to C. Bayard Paschall III, Ph.D., chief of the Ohio Department of Mental Health’s Office of Performance Improvement.

“The question is how we tease some of these characteristics away” from others to be able to associate them with cause of death for patients with serious mental illness, Paschall told Psychiatric News.

Study findings indicate a need for closer collaboration between psychiatry and primary care, according to lead author Brian Miller, M.D., M.P.H., a PGY-2 psychiatry resident at the Medical College of Georgia. In ideal circumstances, patients with serious mental illness could walk from their psychiatrist’s office to an office across the hall to see a primary care physician “who might screen them for some of the comorbid medical conditions we observed in our study,” he said.

In addition, he suggested that psychiatrists and other physicians treating patients who take second-generation antipsychotics carefully monitor these patients for side effects associated with metabolic dysfunction and also write orders for tests of fasting blood glucose, lipid profiles, and liver and thyroid function. Miller and Paschall are conducting further research on some of the factors that may be contributing to excess death rates among people with serious mental illness.

 

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I’m not sure what to draw from that as they don’t mention if the alcohol/drug abuse is co-morbid with mental illnesses. Still, it is sobering and frightening. Especially given just how low on the agenda mental illness is in Britain.

My dad died right on the money- aged 47.11 years.

The Kick Inside

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  The Valproate Family
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  Lamictal
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  The Talk: The Doctor Will Always Discourage You Ever Getting Pregnant
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  Tammy
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  Shite
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  Manic depression is hereditary
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  Crap Poetry Aged 15
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  Sigh

Now, I’m 21 and not planning on getting pregnant anytime soon. Yet, since the day I began treatment, doctors have been protecting my phantom baby. A typical exchange in my psychiatric appointments follows this general structure:

Me, in a whiny voice: “I don’t want to take my Lith-iiiieee-ummmmmm, it makes me feel sick and I have put on tons of weight”. *sad face*

Doctor, in stern, teacherish voice: “If you don’t take your Lithium with your antidepressants then you will have to go to hospital again. And this time for much longer. Months. You will go sky high again”.

Sullen me: “I have already gone sky high even as I was taking Lithium”.

Doctor, exasperated: “Look, Lithium is the safest mood stabiliser for women of your age“.

By “my age” he means of “childbearing age”. Yet apparently Lithium should be avoided during pregnancy as it cause prenatal defects. Which begs the question- just how dangerous are other mood stabilisers to the unborn child?

The Valproate Family

Well, sodium valproate also carries a risk of foetal defects. Read the whole article on valproates, but this in particular is quite sobering:

Of 403 pregnancies in women taking antiepileptic drugs (AEDs), 87.8% resulted in a healthy live birth and 5.2% resulted in a live birth of a child with fetal malformations, ranging from neurologic to genitourinary to skeletal abnormalities. The remaining pregnancies ended in spontaneous abortion or premature death in utero.

The fetal malformation rate was significantly greater in pregnancies exposed to valproate in the first trimester, compared with those exposed to all other AEDs in the first trimester. (16.1% vs. 2.4%). Additionally, the incidence of fetal malformations was significantly higher in women taking valproate than in those taking no AEDs (16.1% vs. 3.1%).

The higher the dosage, the greater the risk according to Diana Mahoney. Reading around, statistics quoted are much the same.

Valproates and Lithium are the two most commonly prescribed true mood stabilisers used to treat Bipolar 1 in the UK.

Lamictal

Bipolar II is often treated using Lamictal. It’s also approved to treat Bipolar 1, but only when stable on other medications. As for Lamictal and pregnancy, there’s little information out there. Best I can find is this from the FDA, which says that babies born during Lamictal treatment are at higher risk of cleft palette.

So, the two “true” mood stabilisers are harmful when pregnant. Information surrounding Lamictal is shady. What can you take during pregnancy, then?

The Talk: The Doctor Will Always Discourage You Ever

Getting Pregnant

I had “The Talk” with my doctor regarding pregnancy. I have always wanted children, loving my little siblings like they were my own, in that freakish big sister way. However, I also have PCOS, meaning my periods come when the damn well want to, which reduces my chance of conceiving and heightens my chance of miscarriage.

When I told my psychiatric doctor this, he was almost relieved. “The Talk” considers the risks of pregnancy to the manic depressive woman.

I’ve been told that if I get pregnant, I can continue Lithium but need to know the risks. Problem is, Lithium is really not that effective for me. It only has a 40% success rate, and Lithium is the first line treatment for mania. So the 60% whose doctors won’t let them switch- where does that leave us?

I’ve also tried Tegretol and Zyprexa, both extremely unsuccessfully. So if I want to reduce the risk to my unborn child (note: not eliminate it), I have to continue taking the ineffective Lithium. Tegretol is also harmful to foetus’.

Another option aside from Lithium is taking an old-school antipsychotic like Haloperidol. Haloperidol is an extremely blunt tool when dealing with complicated mood episodes and carries risks such as tardive dyskinesia. See your neighbourhood schizophrenic who creeps you out because their tongue moves in their mouth like a blind worm? It’s likely they have tardive dyskinesia induced by old school antipsychotics.

Haloperidol and its cousin Thorazine are both pills I have taken and I wouldn’t trust myself on them in pregnancy.

So, that was one part of the talk.

I then got the lowdown on the risks of becoming pregnant. The National Alliance of Mental Illness articulates it pretty starkly:

Because bipolar disorder emerges during young adulthood and persists throughout the lifespan, women of childbearing age are at risk for this illness. Pregnancy and delivery can influence the symptoms of bipolar disorder: pregnant women or new mothers with bipolar disorder have a sevenfold higher risk of hospital admission and a twofold higher risk for a recurrent episode, compared with those who have not recently delivered a child or are not pregnant.

Basically- we might go absolutely nuts.

Tammy

I witnessed this first hand in hospital with a heavily pregnant bipolar woman called Tammy. Tammy was extremely violent and suffering from psychotic delusions. She believed her child was eating her from the inside and would call every day for the nurses to abort it. It was shocking to witness. She was being medicated with Haloperidol and various sedatives and would be quiet every few hours before the halls would rattle with her petrified shrieks.

Shite

Thing is, I have to listen as I know I have a history of psychotic mania and psychotic depression. So it frightens me to know that that most happy of events- carrying a baby- might make me so ill that I could hurt myself or my child.

The doctor was gentle with this information. He’s blunt like that. He wasn’t mean. He was nice but a matter of fact.

I had always feared post-natal depression but I know that in my depressions, save for the bleakest I have experienced, I can always be reached. Some anchor is dropped, some voice is faraway above the well’s mouth, but I can hear it. It’s a whisper, but I can hear it.

Psychosis is not the same. Psychosis is unreachable, unreal, uninhabitable and unimaginable for anyone other than the person locked inside it.

It horrifies me that I might become psychotic while pregnant. That all us manic depressive ladies out there might fear the thing inside them. Or adore it, too much.

If that wasn’t enough to put me off…

Manic depression is hereditary

Mental illness giveth, mental illness taketh away…

While I can see some valuable things I have gained from being a Mentally Interesting Girl diagnosed young-ish, that isn’t something I’d ever want to pass on.

I do have some insight into things I would never have even thought about otherwise. Things like psychosis, mania, depression, suicide and oh, positive things too. Like how people endure and carry on. And how they recognise- by and large- that mental illness sucks, it could be worse. Granted, I only had this sort of self-awareness very recently, but those clear times are quite valuable. My illness is now a part of me. Not the whole of me, but it’s part of my identity because it affects everything at the core of who I am- my moods, my emotions, my energy, my creative abilities.

But, that said, I would never want to pass it on. Manic depression is hereditary. And as well as giving me some insights, it’s taken me on hell-rides, severely truncated what I’m likely to achieve in life and removed a modicum of control from my moods and emotions, on who I could have been.

What we have to ask ourselves then, when we think of getting pregnant or getting someone pregnant- do we want to pass this on?

Crap Poetry Aged 15

When I was 15, I wrote a really shit poem called, “The Heirloom In my Family Is Mental Illness”. Oh woe! I hear you cry. While the rest of the poem was as teenage wankish as you could get, the title did hold truth.

Mental illness runs in my family. There is a vein coursing through us, from my great-grandmother, to her daughter, to my mother, to me. Sadly, it runs thus on the other side too, but that side bred alcoholism, which eventually stole my father from me.

Mental illness can come from nowhere and it can be caused by traumatic life events. But of all the psychiatric illnesses, bipolar disorder seems to have the strongest genetic link.

Sigh
So, I had that merry onslaught chucked at me when my pregnancy questions peeked above the parapet.

Becoming pregnant when you’re manic depressive is tough. It’s not impossible, though. Pregnancy is tough to deal with whatever the circumstances. It’s just that much harder when you suffer from a mental illness. And if we were all afraid of passing on the “faulty gene”, we wouldn’t be here, us Mentally Interesting folks, and that would be a loss.

I’m going to take the advice of Generic Wise Man and wait and see. You never know.