ANTIPSYCHOTIC THERAPY IN PATIENTS WITH COMORBIDITIES: ISSUES AND POLYPHARMACY

Donald C. Goff, M.D., 25 Staniford Street, Boston, MA 02114

Age-adjusted mortality rates in patients with schizophrenia are consistently elevated compared with the normal population and in several studies the increase in mortality rates have ranged from two-to-four-fold. Cardiovascular disease and accidental death (including suicide) appear to make the largest contributions to this increased mortality. Results from surveys of medical illness and mortality in patients with schizophrenia will be reviewed, including a recent study of over 30,000 patients in Massachusetts. Medical risk factors associated with schizophrenia that may contribute to this increase in mortality will be also be reviewed, including cigarette smoking, comorbid substance abuse, and suicide. Experience with clinical approaches to smoking reduction and cessation in schizophrenia patients will be discussed as well as substance abuse treatment. Strategies to reduce mortality from suicide will also be discussed, including identification of risk factors, strategies for preventing self-injurious behavior, and approaches to minimize lethality of overdose.