Thursday, February 1, 2018

Young People With Psychotic Disorder at Highest Risk of Death in Year Following Diagnosis

Young patients newly diagnosed with a psychotic disorder are at higher risk for mortality, mostly due to injuries and poisoning, particularly for the first year or two after diagnosis, according to a study published Wednesday in JAMA Psychiatry.

In fact, the adolescents and young adults studied were more than eight times more likely to die within the first year of being treated for an initial psychotic disorder diagnosis than were patients who received other outpatient services, according to the report by Gregory E. Simon, M.D., M.P.H., of Kaiser Permanente Washington Health Research Institute and colleagues. After initial diagnosis of unipolar depression, patients were three times more likely to die than general outpatients.

For this cohort study, researchers examined eight years of records from several health systems that serve more than 8 million members. They examined records for 11,713 patients aged 16 through 30 who were first diagnosed with a psychotic disorder along with two comparison groups: 35,576 patients who received outpatient services and 23,415 patients with a first diagnosis of unipolar depression.

The researchers found that for every 10,000 patients, 55 of those with a first diagnosis of psychotic disorder died within the first 12 months, compared with 21 deaths of those with first diagnosis of unipolar depression and 7 of those seen by general outpatient services. Of the 64 patients who died within a year of a psychotic disorder diagnosis, more than half were from injuries or poisoning (34% self-inflicted, 17% unintentional). For patients with an initial diagnosis of unipolar depression, more than half of the 48 deaths (54%) were self-inflicted.

Overall mortality and mortality due to injuries and poisonings decreased gradually during the three years after initial diagnosis with psychosis. However, such mortality remained elevated in comparison with patients who received general outpatient health services and those who were newly diagnosed with unipolar depression.

“Our findings support the importance of systematic early intervention for young people experiencing the first onset of psychosis. Strong evidence supports the effectiveness of coordinated specialty care programs for improving clinical outcomes,” the researchers noted. They added that few such patients receive this type of care. Some studies have suggested that continuous treatment with antipsychotic medication may also reduce mortality in this group.

For related information, see the AJP in Advance article “Care Pathways Before First Diagnosis of a Psychotic Disorder in Adolescents and Young Adults” and the Psychiatric News article “Gralnick Award Lecturer Emphasizes Importance of First-Episode Treatment.”

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