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First Episode Psychosis May Lead to Early Death

A new study reporting results from the RAISE project suggests that first episode psychosis increases a patient’s risk of health problems that may lead to premature death.

The Recovery After an Initial Schizophrenia Episode (RAISE) project was developed by the National Institute of Mental Health. The ultimate goal of this major research project is to develop effective prevention and early intervention and reduce the number of people with schizophrenia who experience long-term disability.

Patients with schizophrenia are known to face an increased risk of early death, and this study found that many physical health risks associated with early death arise after the patient experiences a first psychotic episode.

Lifestyle, Mental Health, Medication Contribute to Health Woes

The researchers gathered data from almost 400 individuals being treated for first episode psychosis at 34 community-based clinics. The age of the patients in the study ranged from 15 years to 40 years, with an average age of 24 years. Compared to the general population, these patients had increased incidence of heart disease and metabolic syndrome, which is a combination of conditions that may include high blood pressure, high blood sugar and high cholesterol levels. Smoking was also more common among these patients, although obesity was no more common among first episode psychosis patients that in the general population (since obesity has become a major nationwide problem, this does not mean that many schizophrenia patients are not living with this condition).

Antipsychotic medications also appeared to be a risk factor for significant health concerns. The researchers found that these medications, which are frequently given to first episode psychosis patients, significantly increased the risk of metabolic syndrome. Even patients who took an antipsychotic for only a very short time period were still more likely to have metabolic syndrome. The combination of conditions that may be seen with this syndrome can greatly increase the risk of cardiovascular illness if not brought under control.

Ultimately, the researchers concluded that mental illness itself appeared to be a risk factor for serious health conditions and that this risk was exacerbated by behaviors such as smoking and by antipsychotic medications.

Combined Health Care Approach Needed to Reduce Early Death Risk

Treating an episode of psychosis in patients with schizophrenia is an important priority. Delays in treatment increase the likelihood that eventual recovery will be slow or incomplete. Patients experiencing psychosis, particularly in the acute phase, are subject to delusions, confusion and even hallucinations, which may result in illegal or self-harming activity.

However, lead study author Christoph Correll, M.D., says, “Our results strongly suggest that clinicians need to pay much more attention to promoting physical health in people with severe mental illness.” In the face of such a dramatic mental health crisis like first episode psychosis, it can be easy to overlook physical health concerns. Nevertheless, the results of this study suggest that first episode psychosis is a critical time for physical health as well as mental health. If patients do not receive care for their physical health, they may develop serious illnesses that could significantly shorten their lifespan.

The authors of this study suggest that team-based healthcare is important for first episode psychosis patients so that all aspects of their health are monitored. Programs to help smokers quit should be a priority for some patients, while others may need fitness and nutrition counseling to address obesity, high cholesterol or high blood pressure. There also appears to be a need for antipsychotic medications that do not increase patients’ risk of metabolic syndrome.

Posted on January 13th, 2015
Posted in Mental Health

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