Patients with schizophrenia have a substantially higher risk of all-cause mortality than the general population, with a risk ratio of 2.4. Comorbidities like cardiovascular disease, diabetes, and respiratory illness as well as suicide attempts are associated with increased mortality for schizophrenia patients compared to controls. Preventing and managing metabolic disorders, cardiovascular risks, diabetes, smoking, and obesity through treatment guidelines can help lower mortality risk, but these guidelines remain underutilized for schizophrenia patients. It is important for clinicians to regularly assess schizophrenia patients for suicidal thoughts, depression, medication side effects, and risk factors and utilize medications like clozapine that are approved for suicide prevention when indicated.

1. Schizophreni
The Silent
Killer

3. Is Really Killer?
Schizophrenia affect years of life
Years of potential life lost is 14.5 years
16 years
13 years

4. Is Really
Killer
?
Asian studies African studies
27 years
12.8 year
Asian studies 13
years
African studies 27 years
Life
Expectancy

5. Why?
Suicidali
ty
Co-
mordity

6. Why?
Co-
mordity

7. Hypertensi
on
CATIE schizophrenia trail,
Rate of non- treatment of HTN
In schizophrenics was
60%

8. Diabetes
mellitus
Rate of non-treated diabetes
32%

9. Dyslipidem
ia
Rate of non-treated dyslipidemia
88%

10. 56 % - 88%
smokers
More toxic
exposure
Is associated
with increased
insulin
resistance
Smoking in schizophernics

11. cardiovasc
ular risk
factors
and
schizophre
nia

13. 13
■ Method
A full-population register-based prospective matched-cohort study was
performed including all eligible patients with schizophrenia in Hungary between
01/01/2005 and 31/12/2013. Control subjects were individually matched to
patients with schizophrenia at a 5:1 ratio.The principal outcome measure was
death due to any reason.A non-parametric approach was used for descriptive
statistical purposes, the Kaplan-Meier model for survival analysis, and the Cox
proportional-hazards regression model for inferential statistics.
■ Results
Patients with schizophrenia (n = 65,169) had substantially
higher risk of all-cause mortality
than the control subjects (n = 325,435) (RR = 2.4; P < 0.0001). Comorbidities and
suicide attempts were associated with significantly increased mortality in both
groups. As compared to the controls,

14. Co-
mordity
Cardiovascular risk 2.3X normal population
Diabetes risk 2.7X normal population
Respiratory risk 3.2X normal population
Infectious risk 3.4X normal population

16. Why?
Preventable medical
condition
Modifiable Risk
factors
 Metabolic disorders
 CVS
 DM
 Smoking
 Obesity

17. Why?
Establishing treatment guideline to
lower risk are under-utlized
Follow guidelines
& Take care of drug side
effects

18. Increase
Blood
pressure
Weight gain

19. Why?
Suicidali
ty
Co-
mordity

20. suicidali
ty

21. suicidalit
y
Schizophrenics
680 / 100000
12-25 / 100000
normal population
40X

22. Of
Schizophren
ics
40-60%
Suici
dal
Ideat
ion
suicidalit
y

23. Classic Pt
Who
attempt
Suicide
<30
Painfully
aware of

24. Suicide in
Schizophre
nics is
linked to
 Long term illness
 Family History of
SUICIDE
 Paranoid Delusion
 Drug Abuse
 Past History Of
Depression
 Past History of
Suicide
 Greater number of
medication
 Negative attitude
toward medication

25. High Risk
suicidalit
y

27.  Ask about
suicidal thought
1.Assess
 Ask about
depressive
symptoms
 Ask about Side
effects
(Akasisia)
 Assess Risk
Factors

28. The only
medication
approved by
FDA for
preventing
suicide
2.Clozapine

29. Antipsychot
ics are
proved to
be more
helpful in
controlling
symptoms,
reducing
relapses;
reducing
3.Long Acting
Antipsychotic

30. Syndromal
Or
subsyndrome
4.Anti-
depressants

31. 5.

32. ‫الزتونة‬
 Patients with shiz. had higher risk of mortality
 Comorbidities and suicide were associated with
significantly increased mortality
 Keep in mind the co-morbity
 You may be the only doctor who may see that
patient
 In every schiz pt, assess suicidality,
depressive symptoms, risk factor
 Medication help preventing suicide

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