Risk of Rehospitalization can be Reduced
I read the work of my colleagues Schneider et al. (1) with great interest and would like to share the following experience: it is true that psychotropic drugs may increase risk factors for cardiovascular disease, due to adverse effects. However, antipsychotics can reduce the risk of rehospitalization (also of that due to somatic comorbidity). Paradoxically, it has been shown that some combinations of antipsychotics are even superior to monotherapy (2). Furthermore, it was not mentioned that in particular gerontopsychiatric patients can receive an “overtreatment” due to interactions, even though polypharmacy can lead to an increased mortality. Also, the unhealthy lifestyle of patients with psychosis should be highlighted; patients with schizophrenia have a three-fold increased risk of nicotine abuse, are less active, and have a reduced awareness of the treatability of somatic diseases (3). Even with severe somatic diseases, patients often do not let themselves be adequately treated. In turn, this leads to a recommendation of compulsory treatment, in particular for patients who lack insight regarding treatment. However, outstanding bureaucratic efforts make this implementation unsatisfactory: for instance, from my own experience, I can say that it sometimes can take more than eight weeks to get judicial approval for a necessary surgery of a non-consenting patient. In turn, other patients are often “not manageable” in somatic wards, resulting in inadequate care that may increase the rate of morbidity and mortality. Therefore, care of the mentally ill to reduce somatic comorbidity can be optimized and should take into account both preventive and organizational measures.
Unfortunately, anxiety disorders were not mentioned, although these may be associated with a higher prevalence rate for cardiovascular disease than depression (4).
PD Dr. med. Arnim Quante
Friedrich von Bodelschwingh-Klinik, Berlin, Germany
|1.||Schneider F, Erhart M, Hewer W, Loeffler LAK, Jacobi F: Mortality and medical comorbidity in the severely mentally ill—a German registry study. Dtsch Arztebl Int 2019; 116: 405–11 VOLLTEXT|
|2.||Tiihonen J, Taipale H, Mehtälä J, Vattulainen P, Correll CU, Tanskanen A: Association of antipsychotic polypharmacy vs monotherapy with psychiatric rehospitalization among adults with schizophrenia. JAMA Psychiatry 2019; [Epub ahead of print] CrossRef MEDLINE PubMed Central|
|3.||Kim SW, Park WY, Jhon M, et al.: Physical health literacy and health-related behaviors in patients with psychosis. Clin Psychopharmacol Neurosci 2019; 17: 279–87 CrossRef MEDLINE PubMed Central|
|4.||Roest AM, Zuidersma M, de Jonge P: Myocardial infarction and generalised anxiety disorder: 10-year follow-up. Br J Psychiatry 2012; 200: 324–9 CrossRef MEDLINE|