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Purpose: The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. Methods: Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. Results: The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92–0.97, p < 0.0001; 5-year APR 0.99, 95% CI 0.98–1.00, p = 0.1), but higher following discharge (1-year APR 1.08, 95% CI 1.05–1.11, p < 0.0001, 5-year APR 1.03, 95% CI 1.01–1.05, p < 0.0001). A high proportion of ICU patients received antidepressant, anxiolytic and sedative-hypnotic prescriptions before and after their hospitalization. In multivariable analyses, ICU exposure was associated with an increase in mood, anxiety and psychotic disorders, and sedative-hypnotics use (p < 0.0001 for all Time × Group interactions). Conclusions: During the 5 years after admission to ICU, there is a significant increase in treated prevalence of mental disorders and psychotropic medication use compared to the 5 years prior to ICU and compared to general population and hospital cohorts. Prevention and intervention programs that identify and treat mental disorders among survivors of critical illness warrant further study. [ABSTRACT FROM AUTHOR]

Objective: To estimate incidence of newly diagnosed mental disorders among ICU patients.Design: Retrospective-matched cohort study using a population-based administrative database.Setting: Manitoba, Canada.Participants: A total of 49,439 ICU patients admitted between 2000 and 2012 were compared with two control groups (hospitalized: n = 146,968 and general population: n = 141,937), matched on age (± 2 yr), sex, region of residence, and hospitalization year.Intervention: None.Measurements and Main Results: Incident mental disorders (mood, anxiety, substance use, personality, posttraumatic stress disorder, schizophrenia, and psychotic disorders) not diagnosed during the 5-year period before the index ICU or hospital admission date (including matched general population group), but diagnosed during the subsequent 5-year period. Multivariable survival models adjusted for sociodemographic variables, Charlson comorbidity index, admission diagnostic category, and number of ICU and non-ICU exposures. ICU cohort had a 14.5% (95% CI, 14.0-15.0) and 42.7% (95% CI, 42.0-43.5) age- and sex-standardized incidence of any diagnosed mental disorder at 1 and 5 years post-ICU exposure, respectively. In multivariable analysis, ICU cohort had increased risk of any diagnosed mental disorder at all time points versus the hospitalized cohort (year 5: adjusted hazard ratio, 2.00; 95% CI, 1.80-2.23) and the general population cohort (year 5: adjusted hazard ratio, 3.52; 95% CI, 3.23-3.83). A newly diagnosed mental disorder was associated with younger age, female sex, more recent admitting years, presence of preexisting comorbidities, and repeat ICU admission.Conclusions: ICU admission is associated with an increased incidence of mood, anxiety, substance use, and personality disorders over a 5-year period. [ABSTRACT FROM AUTHOR]

Abstract: Context: The rate of health care and palliative care utilization for patients with schizophrenia near the end-of-life is currently unknown. Objective: Compare rate of health care services, including palliative care, used in the last 6–24months of life for patients with and without schizophrenia. Design: Using the de-identified administrative data Repository at the Manitoba Centre for Health Policy; a matched cohort study between 1995/96 and 2007/08,comparing healthcare services utilized six months to two years prior to death of all (de-identified) decedents with a diagnosis of schizophrenia >10years to decedents without a schizophrenia diagnosis. Setting: province of Manitoba, Canada (population 1.235 million). Participants: Schizophrenia definition: ICD-9-CM 295, or ICD-10-CA code of F20, F21, F23.2, F25 in hospital or physician files, over a 12-year period 1987–1998, in the 12years prior to death for each individual. Decedents were matched (1:3) on age, sex, geography and date of death ±2months. Main outcome measures: Health service utilization rates within six-months to two years prior to death. Results: In the last six months of life, compared to their matched cohort: decedents with schizophrenia had higher rates (52.1% vs. 24.4%, p<.00001) and number of days (89.2 vs. 40.3days, p<.0001) residing in a nursing home; had higher ambulatory visit rates to general practitioners (6.4 vs. 5.5 visits per person, p<.0001), higher rate of visits to psychiatrists (0.53 vs. 0.07 visits per person) and lower rates of seeing other specialists. They were less likely to have opioid analgesia (aRR=0.7157, p-value=0.0006) or to receive palliative care (aOR=0.48, 95% CI 0.41–0.57). Conclusion: End-of-life care is lacking for patients with schizophrenia. Compared to their matched cohort, these patients were much more likely to die in nursing homes, less likely to see specialists (other than psychiatrists), less likely to be prescribed analgesics, and less likely to receive palliative care. [Copyright &y& Elsevier]

Objective: To compare the causes and rates of death for people with and without schizophrenia in Manitoba, Canada., Method: Using de-identified administrative databases at the Manitoba Centre for Health Policy, a population-based analysis was performed to compare age- and sex-adjusted 10-year (1999-2008) mortality rates, overall and by specific cause, of decedents aged 10 years or older who had 1 diagnosis of schizophrenia (ICD-9-CM code 295, ICD-10-CA codes F20, F21, F23.2, F25) over a 12-year period (N = 9,038) to the rest of the population (N = 969,090)., Results: The mortality rate for those with schizophrenia was double that of the rest of the population (20.00% vs. 9.37%). The all-cause mortality rate was higher for people with schizophrenia compared to all others (168.9 vs. 99.1 per thousand; relative risk [RR] = 1.70, P < .0001); rates of death due to suicide (RR = 8.67, P < .0001), injury (RR = 2.35, P < .0001), respiratory illness (RR = 2.00, P < .0001), and circulatory illness (RR = 1.64, P < .0001) were also significantly higher in people with schizophrenia. Overall cancer deaths were similar (28.6 vs. 27.3 per thousand, P = .42, NS) except in the middle-aged group (40-59), in which cancer death rates were significantly higher for those with schizophrenia (28.7 vs. 11.6 per thousand; RR = 2.48, P < .01). Mortality rates due to lung cancer were significantly higher in people with schizophrenia (9.4 vs. 6.4 per thousand, RR = 1.45, P < .001)., Conclusions: People with schizophrenia are at increased risk of death compared to the general population, and the majority of these deaths are occurring in older age from physical disease processes. Risk of cancer mortality is significantly higher in middle-aged but not younger or older patients with schizophrenia. Understanding these patients' vulnerabilities to physical illness has important public health implications for prevention, screening, and treatment as the population ages., (© Copyright 2014 Physicians Postgraduate Press, Inc.)