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Mortality rate higher among young adults with first-episode psychosis
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Recent findings indicated significantly higher mortality rates among young adults with first-episode psychosis but low rates of antipsychotic treatment and psychotherapy.
“These findings show the importance of tracking mortality in individuals with mental illness,” Michael Schoenbaum, PhD, of the NIMH’s Division of Services and Intervention Research, said in a press release. “Health systems do this in other areas of medicine, such as cancer and cardiology, but not for mental illness. Of course, we also need to learn how these young people are losing their lives.”
To assess 12-month mortality and patterns of outpatient and inpatient treatment among individuals who experienced an incident episode of psychosis, researchers conducted a prospective observational analysis of data from the HHS Multi-Payer Claims Database Pilot for all commercially insured individuals aged 16 to 30 years diagnosed with psychosis between 2008 and 2009.
Past-year mortality after psychosis diagnosis ranged from 1,968 per 100,000 to 7,372 per 100,000. These estimates were 24 to 89 times greater than those in the general U.S. population aged 16 to 30 years.
In the year after diagnosis, 61% of participants did not fill an antipsychotic prescription and 41% did not receive psychotherapy.
Sixty-two percent of the cohort experienced at least one hospitalization and/or ED visit during the first year of care.
“The future of this research will show us what is happening with young people in this population, and help us tailor interventions to address their risks,” Schoenbaum said in the release. “In the meantime, this study is a wake-up call telling us that young people experiencing psychosis need intensive, integrated clinical and psychosocial supports.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Oliver Freudenreich, MD, FAPM
How well are you going to do in the United States if you develop a psychotic illness as a young adult? Not well, according to a recent study using claims data from a large database maintained by the HHS.
These findings do not come as a surprise. Recent studies in young first-episode patients have found high rates of medical morbidity already at first clinical presentation and high rates of death from drug use. It is also well-established that most patients with a first-episode of psychosis do not successfully enter into long-term relationships with outpatient care after a first hospitalization. Not pursuing treatment after a first-episode of psychosis is the rule, not the exception.
Death as an outcome of psychosis is particularly tragic as we have effective psychiatric treatment first-episode psychosis. Importantly, young patients with a first-episode of psychosis have an excellent chance of responding well to antipsychotics. In addition, antipsychotics are a highly effective treatment that greatly reduce the psychotic relapse risk. Preventing a pattern of recurrent-remitting illness with all the toxic consequences from untreated psychosis (e.g., job loss, poor ability to address medical issues, accidental death) falls thus into the realm of possibilities.
While we have the tools today to prevent further episodes of psychosis, we need to do a better job engaging with this young population and “selling” our treatments. Far from being ineffective, it is worth emphasizing for example that the effectiveness of antipsychotics mirrors the effectiveness of many medical treatments. Antipsychotics are also available as long-acting injectables that can be given every 2 weeks or 4 weeks, or as infrequently as every 3 months. Not having to rely on taking a daily pill has been shown to greatly reduce relapse risk in first-episode patients. Early use of long-acting antipsychotics ensures treatment leads to clinical stability as the basis for rebuilding a life. By contrast, stuttering or no treatment of psychosis unsurprisingly leads to chronic illness, life-threatening suicidality, and poor self-management.
We need to create a treatment system that truly appreciates the perniciousness of acute psychosis and psychotic relapse and supports all young people with psychosis in their recovery. Proactive, coordinated specialty care with optimal medication management (including long-acting antipsychotics) should be the norm and not the exception, with luck determining who might be able to access such a service.
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