A number of anti-psychotics have been associated with an increase in death. Thioridazine (Mellaril) was the first to be so documented. Haloperidol (Haldol), aripiprazole (Abilify), risperidal (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa) have now been added to the list. However, it is likely to be a general, rather than a specific effect. Avoiding anti-psychotics which cause weight gain probably lowers the death rate. I also give all my psychotic patients folic acid 800 mcg, fish oil 2 grams, magnesium 500 mg and vitamin D 1000-2000 units daily. Both folic acid and fish oil might help reduce psychosis and depression and lower heart death in general. Magnesium and vitamin D both lower the risk of metabolic syndrome, at which patients with schizophrenia are at high risk. Magnesium also lowers the risk of cardiac arrhythmia and death due to heart disease in general, and these are common in patients on anti-psychotics.
Getting patients to stop smoking is much more difficult to accomplish. Few exercise and very few eat a healthy diet of whole grains, fruit, vegetables, beans, lentils, and nuts with an avoidance of sugar, white flour, white pasta, beef, pork, butter, eggs, cheese, and salt.
Anti-Psychotics May Increase the Death Rate: In a 17-year follow-up study of a nationally representative sample of 7,217 Finns over age 29, 39 of the 99 people with schizophrenia died. Adjusted for age and gender, the relative mortality risk between those with schizophrenia and others was increased 184%, and was increased 125% after further adjusting for somatic diseases, blood pressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education. The number of neuroleptics used at the time of the baseline survey showed a graded relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk factors for premature death, the relative risk was increased 150% per increment of one neuroleptic. Schizophrenia, neuroleptic medication and mortality. Joukamaa M, et al. University of Tampere, Finland. . Brit J Psychiatry 2006 Feb;188:122-7. Ed: This is the reason I give all my patients of anti-psychotics magnesium, since cardiac arrhythmias are reduced with magnesium and most or all anti-psychotics cause an increase in arrhythmias.
Schizophrenics Die 15 Years Early: From a review of published studies, the average life expectancy of the general population is 76 years (72 years in men, 80 years in women), whereas the corresponding figure is 61 years (57 years in men, 65 years in women) among patients with schizophrenia, i.e., a 20% reduced life expectancy. Although patients with schizophrenia are 10 to 20 times more likely than the general population to commit suicide, more than two thirds of patients with schizophrenia, compared with approximately one-half in the general population, die of coronary heart disease (CHD). The chief risk factors for this excess risk of death are cigarette smoking, obesity leading to dyslipidemia, insulin resistance and diabetes, and hypertension. Schizophrenia and increased risks of cardiovascular disease. Hennehens CH, et al. Florida Atlantic University. . Am Heart J 2005 Dec;150(6):1115-21.
Sudden Death More Common: Patients with schizophrenia have been reported to be 3 times as likely to experience sudden unexpected death than individuals from the general population. How much is due to medication is uncertain. J Psychiatry Neurosci 2005 Nov;30(6):393-395.
Death in Dementia Increased 54% by Zyprexa, Abilify, Seroquel, and Risperdal: In a meta-analysis of 15 studies (9 unpublished), generally 10 to 12 weeks in duration, including 16 contrasts of atypical antipsychotic drugs with placebo (aripiprazole [n = 3], olanzapine [n = 5], quetiapine [n = 3], risperidone [n = 5]) with a total of 3353 patients randomized to study drug and 1757 randomized to placebo., death occurred more often among patients randomized to drugs (118 [3.5%] vs 40 [2.3%]. The OR by meta-analysis was 1.54; P = .02; and risk difference was 0.01; P = .01). Sensitivity analyses did not show evidence for differential risks for individual drugs, severity, sample selection, or diagnosis. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. Schneider LS, et al. University of Southern California. . JAMA 2005 Oct 19;294(15):1934-43. Ed: While the industry-friendly authors call the 54% increase "a small increased risk," it looks like a very large increase to me.
Death Due to Anti-Psychotics, Both Traditionals and Atypicals: A new VA study of 100,000 patients with dementia found that those on traditional anti-psychotics (474) had an increased rate of death of 82%, while those on atypicals (5,062) had a 64% increase, not a significant difference. While this was not a random-assignment study, it's results are similar to the double blind studies. Also, the increased death rate was present throughout the 1 year of follow-up (Kales H, et al. Ann Arbor VA. 2006 meeting of the Amer Assoc for Geriatric Psychiatry).
Schizophrenics Similar to Those 10-15 Years Older: In a retrospective, cross-sectional, multicenter study in which 117 Spanish psychiatrists (the CLAMORS Study Collaborative Group), patients with schizophrenia and receiving antipsychotic treatment for at least 12 weeks. Metabolic syndrome was present in 24.6%. The overall 10-year risks of death from stroke was 0.9 and coronary vascular disease 7.2. Abdominal obesity and low HDL-cholesterol were more prevalent in women: 54.5% versus 34.3% , and 46.1% versus 28.5, p<0.00. Hypertension and hypertriglyceridemia were more prevalent in men: 59.0% versus 46.0%, and 40.7% versus 32.4, p<0.01. CHD risk and MS prevalences among patients with schizophrenia treated with antipsychotics were in the same range as the Spanish general population 10 to 15 years older. Metabolic Syndrome was defined by at least 3 of the following components: waist circumference >102 (men)/>88 (women) cm; triglycerides >/=150 mg/dl; HDL-cholesterol <40 mg/dl (men)/<50 mg/dl (women); blood pressure >/=130/85; fasting glucose >/=110 mg/dl. Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: Results of the CLAMORS Study. Bobes J, et al. University of Oviedo, Asturias, Spain. Schizoph Res 2006 Nov 20.