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June 6, 2011

Systematic Review of Early Cardiometabolic Outcomes of the First Treated Episode of Psychosis

Author Affiliations

Author Affiliations: Applied Genetics and Biostatistics, Orygen Youth Health Research Centre (Dr Foley), and Centres for Youth Mental Health (Dr Foley) and Molecular, Environmental, Genetic, and Analytic Epidemiology, School of Population Health (Dr Morley), the University of Melbourne, Parkville, Victoria, Australia; and Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, England (Dr Morley).

Arch Gen Psychiatry. 2011;68(6):609-616. doi:10.1001/archgenpsychiatry.2011.2

Twenty-five years after diagnosis, individuals with schizophrenia have a mortality risk that is 3 times that of the general population.1 Although risk of suicide is increased 18-fold over 25 years,1 the very low base rate for suicide in the wider community means that the major cause of mortality and morbidity among individuals with schizophrenia is actually natural causes, predominantly cardiovascular disease.1,2 Antipsychotic drugs, such as clozapine, can save lives by reducing the impulsiveness and aggression that can lead to suicide3,4 but they can also alter risk for cardiovascular disease by causing weight gain5,6 and possibly hypertension and lipid and glucose abnormalities.7 The risk for cardiovascular disease appears to be increasing among individuals with schizophrenia,1 creating an ever-widening gap between the life expectancy of the seriously mentally ill and the broader community.8 Determining if antipsychotic drugs reduce or increase overall mortality associated with schizophrenia or other psychoses is therefore a pressing issue9,10 and the identification of, and intervention directed at, modifiable risk factors for cardiovascular disease among the seriously mentally ill, a clinical imperative.

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