Table 1 Somatic co-morbidity of schizophrenia patients

Jones, 2004 [13]. USA

1996–2000

Cross-sectional comparative study of Medicaid claims

147 pts with SMI (78 schizophr. pts)

Prevalence: 74% of pts with SMI were treated for a chronic physical health problem. 50% had two or more chronic physical diseases. Chronic pulmonary disease was most prevalent: 31%

Risk adjustment for physical health is essential when setting performance standards or cost expectations for mental health treatment.

Dixon, 2000[14]. USA

1991–1996

Retrospective analysis of 2 databases and interviews (PORT)

Medicaid 6066;

Medicare 14182;

PORT 719

Prevalence: Schizophr. pts treated for DM: 9–14%. DM in schiz. pts. aged 65+: 18.8–20.8%; DM in schizophr. women: 15%–21.9%; DM in schizophr. black pts: 11.6–18.5%

Before the widespread use of the atypical antipsychotic drugs, diabetes was a major problem for persons with schizophrenia. Being older, female, or black increased the likelihood of DM.

Carlson, 2006[15]. UK

1994–2002

Retrospective cohort study in UK General Practice Research Database

59089 conv. antipsych users; 9053 atyp antipsych users; 1491548 ctrls

HR of DM: conv. antipych: 1.9; atyp. antipsych: 2.9

There is an increased risk of developing diabetes during treatment with antipsychotics.

Sacchetti, 2005[16]. Italy

1996–April 2002

Retrospective age- and sex-matched cohort study in a general practitioners database

2071 haloper.

266 olanzap.

567 risperid.

109 quetiapine

6012 ctrls

HR of DM conv. antipsych: haloperidol: 12.4; atyp antipsych: olanzapine: 20.4; risperidone: 18.7; quetiapine: 33.7

The incidence of diabetes is significantly higher in patients taking antipsychotics.

Kornegay, 2002[17]. UK

1994–1999

Nested case-control study in UK General Practice Research Database

424 newly diagnosed DM pts vs. 1522 ctrls

OR of current antipsych. exposure in pts. with incident DM: 1.7

This study showed an increased risk of incident diabetes among current users of atypical and conventional antipsychotic medication.

Meyer, 2005 [18]. USA

2001–June 2003

Cohort study, using baseline data from CATIE Schizophrenia Trial

1231 schizophr. pts

18–65 years of age

Prevalence of metabolic syndrome in schizophr. pts: 35.8%. Pts with metab. syndr. rate themselves lower on physical health.

The metabolic syndrome is highly prevalent in schizophr. pts and is strongly associated with a poor self-rating of physical health and increased somatic preoccupation.

Lamberti, 2006[19]. USA

Not mentioned

Cross-sectional comparative study

93 clozapine users vs. 2701 ctrls

Prevalence of metabolic syndrome: clozapine: 53.8%; controls: 20.7%

Patients receiving clozapine are at significantly increased risk for developing the metabolic syndrome.

Osborn, 2006[20]. UK

2003

Cross-sectional screening

74 pts with SMI vs. 48 ctrls

OR of raised 10-years CHD risk among patients with SMI: 1.8; OR of raised chol/HDL ratio: 1.8. OR of DM: 3.8. OR of smoking: 3.0

Patients with non-affective chronic psychotic illness have excess risk factors for coronary heart disease, which are not wholly accounted for by medication or socio-economic deprivation.

Samele, 2007[21]. UK

1999–2001

Case-control study of first episode psychosis (FEP) patients

89 FEP pts vs.

89 ctrls matched on age and sex

OR of current physical illness: 2.85. OR of smoking: 1.82. OR of eating fast-food: 1.04

Some risk factors for physical health problems are present at the onset of psychosis, but these may be explained by unemployment.

Himelhoch, 2004[22]. USA

Mrt 2000–Dec 2000

Cross- sectional comparative survey

185 SMI pts vs. 2706 ctrls matched on age, gender, and race

Prevalence of: current smoking 60,5%, COPD 22.6%, astma 18.5%

Prevalence of COPD is significantly higher among patients with SMI. Predictive factors were age, being male, and being a current smoker.

Carney, 2005[23]. USA

1996–2002

Retrospective analysis of longitudinal claims data

1074 pts with schizophr. or schizoaffective disorder vs. 726262 ctrls

OR of: COPD 1.88, complicated DM 2.11, hypothyreoidism 2.62, hepatitis C 7.54, electrolytdisorders 4.21

Schizophrenia is associated with substantial chronic medical burden. Familiarity with conditions affecting schizophr. pts may assist programs aimed at providing medical care for the mentally ill.

Lichtermann, 2001[24]. Finland

1971–1996

Cohort study

26.996 schizophr. pts, 39131 parents, 52976 siblings

SIR of: cancer incidence 1.17, lung cancer 2.17, pharynx cancer 2.60

Schizophr. pts have an increased risk of pharynx- and lung cancer. This may be the consequence from lifestyle factors, particularly tobacco smoking and alcohol consumption.

Hippisley-Cox, 2007 [25]. UK

1995–2005

Population-based nested case-control study

139 schizophr. pts vs. 571 ctrls

OR of mamma ca 1.52, colon ca 2.90, respiratory ca 0.53

Schizophr. pts have a higher risk of colon cancer and a lower risk of respiratory cancer compared with controls after adjustment for confounders.

Kuritzky, 1999[26]. Israël

1999

Cross-sectional comparative survey

108 schizophr. pts vs. 100 ctrls

Prevalence of headache in pts: 48%; headache in ctrls: 41%. No sign. difference on comparing the type of headache between groups.

Schizophr. pts describe the same type, frequency, severity and duration of headache compared with controls, but tend to refrain from complaining about their headache.

Viertiö, 2007[27]. Finland

Sept 2000–June 2001

Cross-sectional comparative study

Distance VA measured: 56 schizophr. pts vs. 6588 ctrls.

Near VA measured: 51 schizophr. pts vs. 6415 ctrls

OR of schizophr. pts with visual impairment for distance: 5.04 and for near vision: 6.22 Prevalence of schizophr. pts having visual examination during previous 5 years: 43.9%. vs. total sample: 69.7%

Schizophr. pts attend visual examinations less frequently than others, and their vision is notably weaker. Regular ocular evaluations should be included in physical health monitoring.