BMJ mental health最新文献

Background: A higher prevalence of neurological conditions has been found in schizophrenia, bipolar disorder and other psychotic illnesses compared to the general population. We aimed to understand the cumulative prevalence of 15 neurological conditions in people with severe mental illness (SMI) from 5 years before to 5 years after their SMI diagnosis.

Methods: We identified patients with SMI, aged 18-100 years from 1 Jan 2000 to 31 Dec 2018, from the UK Clinical Practice Research Datalink. Each SMI patient was matched 1:4 to individuals without SMI. The cumulative prevalence of 15 neurological conditions was recorded at 5, 3 and 1 years prior to SMI diagnosis; at SMI diagnosis; and 1, 3 and 5 years after SMI diagnosis. Prevalences were compared with logistic regression.

Results: We identified 68 789 patients with SMI and 274 827 comparators. Of 15 neurological conditions, 13 (multiple sclerosis, cerebrovascular disease, dementia, ataxic disorders, epilepsy, Parkinson's disease, other parkinsonism, paralysis, other movement disorders, cerebrospinal fluid disorders, cerebral palsy, disorders of nerve root, plexus or peripheral nerves and autonomic disorders) were more prevalent in SMI compared with comparators at the time of SMI diagnosis. Dementia (OR: 4.22; 95% CI 3.88 to 4.58), epilepsy (OR: 3.01; 95% CI 2.83 to 3.19) and Parkinson's disease (OR: 3.97; 95% CI 3.45 to 4.57) were particularly elevated at 5 years post-SMI diagnosis.

Conclusions: Many neurological conditions have higher prevalence in the SMI cohort compared with those without SMI. The different prevalence patterns observed in our study highlight the need to establish the causal pathways between specific SMI and neurological disease diagnoses.

Background: One in four cases of schizophrenia begins in late life, resulting in high unemployment and reduced life expectancy. However, knowledge of the modifiable risk factors for late-onset schizophrenia and their combined effects is limited.

Aims: To identify modifiable risk factors for late-onset schizophrenia and estimate their joint disease risk effects.

Methods: This prospective cohort study using UK Biobank data included 482 708 participants without late-onset schizophrenia at baseline, followed up for a mean of 14.36 years. We conducted an exposure-wide association study of 232 potentially modifiable factors linked to late-onset schizophrenia risk. Late-onset schizophrenia is diagnosed using ICD-10 (International Classification of Diseases, 10th Revision) criteria. Cox proportional hazard models identified significant factors across six domains: lifestyle, environment, medical history, physical measures, mental health and socioeconomic status (SES). Domain-specific weighted scores were calculated from Cox model coefficients and stratified into tertiles (favourable, intermediate, unfavourable) for risk assessment. Population attributable fractions (PAFs) quantified prevention potential.

Results: During follow-up, 1276 participants developed late-onset schizophrenia. We identified 109 significant potentially modifiable factors, with intellectual disability (HR 35.15, 95% CI 11.23 to 110.09), manic episode (HR 33.14, 95% CI 21.16 to 51.90) and bipolar affective disorder (HR 32.91, 95% CI 27.07 to 40.01) showing the strongest risks, while higher household income (>£100 000: HR 0.14, 95% CI 0.09 to 0.22), regular friends/family visits (HR 0.23, 95% CI 0.18 to 0.28) and higher hand grip strength (HR 0.35, 95% CI 0.29 to 0.44) showed the strongest protection. PAF estimations indicated that shifting individuals from unfavourable to intermediate/favourable risk profiles could prevent 71.3% (95% CI 71.2% to 71.4%) of late-onset schizophrenia cases, mainly from mental health (25.1%, 95% CI 25.0% to 25.2%), medical history (13.6%, 95% CI 13.5% to 13.7%) and SES domain (11.2%, 95% CI 11.1% to 11.3%); shifting individuals from intermediate/unfavourable risk profiles to favourable could prevent 89.2% of cases.

Conclusions: A substantial proportion of late-onset schizophrenia risk appears modifiable, with mental health and medical history as key contributors. Physical health and natural environment exposure provided protective benefits. Findings supported integrating clinical interventions and structural changes addressing socioeconomic and environmental factors to reduce late-onset schizophrenia burden.