August 2008

Options for SSRI-Resistant Depression in Adolescents
In a study by Brent et al, depressed adolescents who did not respond sufficiently to an SSRI benefited from switching to a different antidepressant and cognitive behavioral therapy.

High-Dose Olanzapine in Treatment-Resistant Schizophrenia
For some treatment-resistant patients with schizophrenia, high-dose olanzapine might be a better option than clozapine.

Increased Stroke Risk in Schizophrenia Patients
Patients with schizophrenia appear to have an increased risk of stroke, and the risk may be higher for women than for men.

Tamoxifen for Mania?
Through inhibition of protein kinase C, tamoxifen may benefit patients with mania and merits further study.

In Brief
Genetic Variations in Patients with Schizophrenia; Zonisamide for Weight Loss in Bipolar Disorder; Music Therapy for Stroke Recovery

NMS in Children and Adolescents
The neuroleptic malignant syndrome is a risk in children and adolescents treated with second-generation antipsychotics.

Increased Stroke Risk in Schizophrenia Patients

August 2008

As we frequently point out, health risks are elevated for people with chronic mental illness. For example, patients with schizophrenia may have an increased risk of developing colon cancer (BTP 2008;31:16).1 A 2004 paper reported that patients with schizophrenia also have about a two-fold increased risk of developing stroke.2 Researchers in Taipei appear to have confirmed that finding.

Lin and collaborators examined records of more than 5000 patients under 45 years old hospitalized for schizophrenia.3 To avoid confounding the stroke risk with institutionalization, chronicity, or medications, investigators evaluated only patients who had not received any psychiatric treatment during the previous 2 years. For comparison, they selected approximately 10,000 patients of comparable ages who had undergone appendectomies in the same year.

During the 5-year follow-up period, 219 (1.46%) of the 15,000 patients developed strokes. Among schizophrenia patients, the incidence was 2.46% compared with 0.9% in the comparison cohort. Following adjustment for potential confounding health risks, the risk of stroke in schizophrenia patients was found to be approximately twice that of the age-matched appendectomy patients (P < .001). Strikingly, the risk was much higher among female patients with schizophrenia: 2.87 times greater than the comparison group for women versus 1.64 times greater for men.

With medications in the preceding 2 years excluded as a potential contributor to the increased stroke risk, we are left to wonder about the potential long-term effects of medication, along with such well-known risk factors as poor diet, lack of exercise, development of contributing medical conditions such as hypertension, and conceivably a risk inherent in the psychiatric condition itself. For now, this study reminds us to be cognizant of the health status of patients with chronic mental illness—even those who are relatively young.

1Hippisley-Cox J, Vinogradova Y, Coupland C, Parker C: Risk of malignancy in patients with schizophrenia or bipolar disorder: Nested case-control study. Arch Gen Psychiatry 2007;64:1368-1376.

2Curkendall SM, Mo J, Glasser DB, Rose Stang M, Jones JK: Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada. J Clin Psychiatry 2004;65:715-720.

3Lin HC, Hsiao FH, Pfeiffer S, Hwang YT, Lee HC: An increased risk of stroke among young schizophrenia patients. Schizophrenia Res 2008;101:234-241.