title: Mortality and its determinants in people with psychotic disorder.
abstract: OBJECTIVE
  We investigated mortality and its determinants in people with psychotic disorder.
  
  
  METHODS
  A nationally representative two-stage cluster sample of 8028 persons aged 30 years or older from Finland was selected for a comprehensive health survey conducted from 2000 to 2001. Participants were screened for psychotic disorder, and screen-positive persons were invited for a Structured Clinical Interview for DSM-IV. The diagnostic assessment of DSM-IV psychotic disorders was based on the Structured Clinical Interview for DSM-IV, case records from mental health treatments, or both. Mortality was followed up until September 2009 and analyzed using Cox proportional hazards model.
  
  
  RESULTS
  People with schizophrenia (hazard ratio [HR] = 3.03; 95% confidence interval [CI] = 1.93-4.77) and other nonaffective psychoses (HR = 1.84; 95% CI = 1.17-2.91) had elevated mortality risk, whereas people with affective psychoses did not (HR = 0.61; 95% CI = 0.24-1.55). Antipsychotic medication use was associated with increased mortality (HR = 2.34; 95% CI = 1.86-2.96). There was an interaction between antipsychotic medication use and the presence of a psychotic disorder: antipsychotic medication use was only associated with elevated mortality in persons who were using antipsychotics and did not have primary psychotic disorder. In persons with psychotic disorder, mortality was predicted by smoking and Type 2 diabetes at baseline survey.
  
  
  CONCLUSIONS
  Schizophrenia and nonaffective psychoses are associated with increased mortality risk, whereas affective psychoses are not. Antipsychotic medication use increases mortality risk in older people without primary psychotic disorder, but not in individuals with schizophrenia. Smoking and Type 2 diabetes are important predictors of elevated mortality risk in persons with psychotic disorder.
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute forHealth and Welfare, Helsinki, Finland. jaana.suvisaari@thl.fi
authors.forename: Jaana
authors.initials: J
authors.lastname: Suvisaari
authors.forename: Krista
authors.initials: K
authors.lastname: Partti
authors.forename: Jonna
authors.initials: J
authors.lastname: Perälä
authors.forename: Satu
authors.initials: S
authors.lastname: Viertiö
authors.forename: Suoma E
authors.initials: SE
authors.lastname: Saarni
authors.forename: Jouko
authors.initials: J
authors.lastname: Lönnqvist
authors.forename: Samuli I
authors.initials: SI
authors.lastname: Saarni
authors.forename: Tommi
authors.initials: T
authors.lastname: Härkänen
mesh_terms: D000328:Adult; D000341:Affective Disorders, Psychotic / Q000188:drug therapy / Q000401:mortality*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy / Q000401:mortality*; D012907:Smoking / Q000401:mortality
chemical_list: D014150:Antipsychotic Agents