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Background People with psychotic disorders have a markedly reduced life expectancy compared to the general population. Comorbid substance use disorders (dual diagnosis) contribute towards poorer treatment engagement and worse clinical outcomes but their impact on mortality is uncertain. We estimated the association of comorbid substance use disorders with life expectancy in a large sample of patients with psychotic disorders using an electronic health record (EHR) case register. Methods Data were obtained from 29,412 people with schizophrenia (61.9%), schizoaffective disorder (4.9%) or bipolar disorder (33.2%) receiving mental healthcare from the South London and Maudsley NHS Foundation Trust between 1st January 2007 and 31st December 2017. The Clinical Record Interactive Search tool (CRIS) was used to extract data on age, gender, ethnicity, comorbid substance use disorders (ICD-10 F10-19) and mortality from anonymised EHRs. The Chiang II method was used to estimate life expectancy from birth associated with substance use disorders using life-table data obtained from the UK Office of National Statistics. Results 3,657 patients had a comorbid substance use disorder of whom 70.1% were male. The most frequently documented comorbid substance use disorders were related to alcohol (44.9%), multiple drug use (31.3%) and cannabis (25.2%). 3,396 patients died during the study period. The life expectancy for patients with a comorbid substance use disorder was 63.1 years (95% CI 60.7 – 65.5) for men and 63.4 years (95% CI 60.2 – 66.7) for women. The life expectancy for patients without a comorbid substance use disorder was 65.1 years (95% CI 64.1 – 66.0) for men and 69.8 years (95% CI 68.9 – 70.8) for women. Patients with a comorbid substance use disorder were more likely to die of unnatural causes (28.5%) compared to those without (10.0%). Discussion Comorbid substance use disorders were most frequently recorded among male patients but associated with greatest reduction in life expectancy among female patients. Patients with a comorbid substance use disorder were almost three times more likely to die from unnatural causes (accidental, suicide or homicide). These findings demonstrate the need to better address comorbid substance use disorder in people with psychotic disorders, particularly among female patients who experienced a marked reduction of around six years in life expectancy. [ABSTRACT FROM AUTHOR]

Background Treatment with paliperidone palmitate (PP) has been shown to reduce hospitalisation, however its effect on broader service use remains unknown. Our objectives were to describe and compare the health care professional (HCP) use of patients treated with 1-monthly PP before and after its initiation. Methods Data were sourced from South London and Maudsley (SLAM) electronic health records on patients diagnosed with schizophrenia, who had received 1-monthly PP for at least 365 days. We employed two mirrored image analyses to determine the number and frequency of HCP contacts in the 12 months before and after PP initiation: 1) excluding all inpatient days at the time of initiation; 2) excluding only the post-initiation days for that stay. More specifically, we looked at face-to-face, telephone contacts, days spent as an inpatient and number of active days in the service. Results Of 664 patients who had received PP (mean age 42 years), 60.1% were male, 60.1% of black ethnicity, 78.5% single, and 82.7% unemployed; 56.5% of initiations occurred during inpatient episodes. The two mirror image analyses yielded similar results following PP initiation, inpatient bed-days were lower (mean (SD)) with the number of bed-days before and after initiation respectively: 31.6 (52.0) and 21.1 (52.9) in model 1; 45.1 (64.0) and 21.1 (52.9) in model 2; both p<0.001). Significant post- vs. pre-initiation period HCP contact differences (model 2; respective mean (SD) contact numbers) included fewer face-to-face contacts with nurses (15.3 (12.7) vs. 17.6 (16.9), p<0.001) social workers (3.3 (6.1) vs. 4.0 (5.), p<0.001), medical staff (1.2 (2.1) vs. 1.7 (3.0), p<0.001) and unspecified professionals (0.9 (3.1) vs. 1.3 (4.7), p<0.001); and increased contact with clinical psychologists (0.9 (3.6) vs. 0.6 (2.6), p=0.04). Total staff face-to-face contact numbers reduced to mean (SD) 25.8 (20.4) from 29.7 (24.9) (p<0.001). Numbers of phone contacts showed similar changes comparing the post- vs. pre-initiation periods: reduced total contacts (8.7 (8.7) vs. 11.0 (10.5), p<0.001), and those with nursing (4.9 (5.9) vs. 6.1 (7.4), p<0.001), social work (2.0 (5.7) vs. 3.0 (5.7), p<0.001), medical (0.1 (0.4) vs. 0.2 (0.8), p<0.001) and unspecified (0.2 (0.8) vs. 0.4 (1.4), p<0.001) professionals; increased contact with clinical psychologists (0.24 (1.1) vs. 0.19 (0.9), p=0.03). Discussion Our findings indicate a change in the profile of inpatient bed days and HCP contacts following initiation of 1-monthly PP, consistent with a transition from treatment to rehabilitation. [ABSTRACT FROM AUTHOR]