Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T18:34:11.308Z Has data issue: false hasContentIssue false
  • English
  • Français

End-of-life care in schizophrenia: a systematic review

Published online by Cambridge University Press:  19 June 2020

Joshua M. Baruth ,
Jacqueline B. Ho ,
Sohail I. Mohammad  and
Maria I. Lapid
Joshua M. Baruth
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Jacqueline B. Ho
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Sohail I. Mohammad
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
Maria I. Lapid*
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
*
Correspondence should be addressed to: Maria I. Lapid, Mayo Clinic, Department of Psychiatry and Psychology, 200 First Street SW, Rochester, MN55905, USA. Phone: +1 (507) 284 4159; Fax: +1 (507) 284 4158. Email: [email protected].
Get access

Abstract

Objective:

Schizophrenia is a severe and persistent mental illness with profound effects on patients, families, and communities. It causes immense suffering on personal, emotional, and socioeconomic levels. Individuals with schizophrenia have poorer health outcomes and die 10–20 years younger than the general population. Economic costs associated with schizophrenia are substantial and comprise 2.5% of healthcare expenditures worldwide. Despite psychosocioeconomic impacts, individuals with schizophrenia are subject to inequitable care, particularly at end of life. A systematic review was conducted to examine disparities in end-of-life care in schizophrenia and identify factors that can be targeted to enhance end-of-life care in this vulnerable population.

Design:

A comprehensive search was conducted using the databases Ovid MEDLINE(R), Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus from 2008–2018. Keywords included schizophrenia, palliative, end-of-life, and hospice. Two authors independently reviewed titles and abstracts; disagreements were resolved by consensus.

Results:

The search identified 123 articles; 33 met criteria: 13 case reports, 12 retrospective studies, 5 literature reviews, and 3 prospective studies. Articles were divided into major themes including healthcare disparities, ethics, and palliative care. Palliative care was the most frequent theme comprising >50% of the articles, and there was considerable thematic overlap with ethics and palliative care. Almost half the articles (45%) were related to schizophrenia and comorbid cancer.

Conclusions:

Increased awareness of potential healthcare disparities in this population, creative approaches in multidisciplinary care, and provision of adequate palliative services and resources can enhance end-of-life care in schizophrenia.

Keywords

palliativehospiceserious and persistent mental illnesspsychotic disorderdisparityquality-of-life
Type
Review Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 2: Issue Theme: Schizophrenia and Depression in Older Adults , February 2021 , pp. 129 - 147
Copyright
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.Google Scholar
Baldinger-Melich, P. et al. (2016). Treatment-resistant catatonia – a case report. Clinical Neuropsychiatry, 13, 24–27. Google Scholar
Beauchamp, T.L. and Childress, J.F. (2001). Principles of Biomedical Ethics. New York: Oxford University Press.Google Scholar
Berk, M. et al. (2012). Palliative models of care for later stages of mental disorder: maximizing recovery, maintaining hope, and building morale. Australian & New Zealand Journal of Psychiatry, 46, 92–99. doi: 10.1177/0004867411432072 CrossRefGoogle ScholarPubMed
Brundtland, G.H. (2000). Mental health in the 21st century. Bulletin of the World Health Organization, 78, 411. Google ScholarPubMed
Cai, X., Cram, P. and Li, Y. (2011). Origination of medical advance directives among nursing home residents with and without serious mental illness. Psychiatric Services, 62, 61–66. doi: 10.1176/ps.62.1.pss6201_0061 CrossRefGoogle ScholarPubMed
Chang, C.K. et al. (2014). A cohort study on mental disorders, stage of cancer at diagnosis and subsequent survival. BMJ Open, 4. doi: 10.1136/bmjopen-2013-004295 CrossRefGoogle ScholarPubMed
Chochinov, H.M., Martens, P.J., Prior, H.J. and Kredentser, M.S. (2012). Comparative health care use patterns of people with schizophrenia near the end of life: a population-based study in Manitoba, Canada. Schizophrenia Research, 141, 241–246. doi: 10.1016/j.schres.2012.07.028 CrossRefGoogle ScholarPubMed
Chong, H.Y., Teoh, S.L., Wu, D.B., Kotirum, S., Chiou, C.F. and Chaiyakunapruk, N. (2016). Global economic burden of schizophrenia: a systematic review. Neuropsychiatric Disease Treatment, 12, 357–373. doi: 10.2147/NDT.S96649 Google ScholarPubMed
Cohen, A.S., Le, T.P., Fedechko, T.L. and Elvevag, B. (2017). Can RDoC help find order in thought disorder? Schizophrenia Bulletin, 43, 503–508. doi: 10.1093/schbul/sbx030 CrossRefGoogle ScholarPubMed
De Hert, M., Dekker, J.M., Wood, D., Kahl, K.G., Holt, R.I. and Moller, H.J. (2009). Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Europen Psychiatry, 24, 412–424. doi: 10.1016/j.eurpsy.2009.01.005 CrossRefGoogle Scholar
Ganzini, L., Socherman, R., Duckart, J. and Shores, M. (2010). End-of-life care for veterans with schizophrenia and cancer. Psychiatric Services, 61, 725–728. doi: 10.1176/ps.2010.61.7.725 CrossRefGoogle ScholarPubMed
Gervaix, J., Haour, G., Michel, M. and Chevreul, K. (2019). Impact of mental illness on care for somatic comorbidities in France: a nation-wide hospital-based observational study. Epidemiology and Psychiatric Science, 28, 495–507. doi: 10.1017/S2045796018000203 CrossRefGoogle ScholarPubMed
Hirokawa, S. et al. (2012). Psychosocial and psychiatric characteristics of suicide completers with psychiatric treatment before death: a psychological autopsy study of 76 cases. Psychiatry & Clinical Neurosciences, 66, 292–302. doi: 10.1111/j.1440-1819.2012.02343.x CrossRefGoogle ScholarPubMed
Ho, P. and Rosenheck, R. (2018). Substance use disorder among current cancer patients: rates and correlates nationally in the department of veterans affairs. Psychosomatics, 59, 267–276. doi: 10.1016/j.psym.2018.01.003 CrossRefGoogle ScholarPubMed
Hsu, Y.H., Cheng, J.S., Ouyang, W.C., Lin, C.L., Huang, C.T. and Hsu, C.C. (2015). Lower incidence of end-stage renal disease but suboptimal pre-dialysis renal care in schizophrenia: a 14-year nationwide cohort study. PLoS One, 10, e0140510. doi: 10.1371/journal.pone.0140510 CrossRefGoogle ScholarPubMed
Huang, H.-K., Wang, Y.-W., Hsieh, J.-G. and Hsieh, C.-J. (2018). Disparity of end-of-life care in cancer patients with and without schizophrenia: a nationwide population-based cohort study. Schizophrenia Research, 195, 434–440. doi: 10.1016/j.schres.2017.10.029 CrossRefGoogle ScholarPubMed
Irwin, K.E., Henderson, D.C., Knight, H.P. and Pirl, W.F. (2014). Cancer care for individuals with schizophrenia. Cancer, 120, 323–334. doi: 10.1002/cncr.28431 CrossRefGoogle ScholarPubMed
Kadri, A., Blackmer, J. and Ibrahim, M. (2014). Obtaining consent to a life-sustaining treatment for a patient with a major psychiatric illness. CMAJ, 186, 1087–1089. doi: 10.1503/cmaj.130714 CrossRefGoogle ScholarPubMed
Laursen, T.M., Nordentoft, M. and Mortensen, P.B. (2014). Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 10, 425–448. doi: 10.1146/annurev-clinpsy-032813-153657 CrossRefGoogle Scholar
Manemann, S.M. et al. (2018). Multimorbidity and functional limitation in individuals with heart failure: a prospective community study. Journal of the American Geriatrics Society, 66, 1101–1107. doi: 10.1111/jgs.15336 CrossRefGoogle ScholarPubMed
Martens, P.J., Chochinov, H.M. and Prior, H.J. (2013). Where and how people with schizophrenia die: a population-based, matched cohort study in Manitoba, Canada. Journal of Clinical Psychiatry, 74, e551–557. doi: 10.4088/JCP.12m08234 CrossRefGoogle ScholarPubMed
McNamara, B., Same, A., Rosenwax, L. and Kelly, B. (2018). Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need. BMC Palliative Care, 17, 53. doi: 10.1186/s12904-018-0309-1 CrossRefGoogle ScholarPubMed
Meyer, A.A. et al. (2013). Metastatic breast cancer in patients with schizophrenia. Molecular & Clinical Oncology, 1, 359–364. CrossRefGoogle ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J. and Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6, e1000097. doi: 10.1371/journal.pmed.1000097 CrossRefGoogle ScholarPubMed
Moini, B. and Levenson, J.L. (2009). A forgotten diagnosis: simple schizophrenia in a patient with breast cancer. Psychosomatics, 50, 87–89. doi: 10.1176/appi.psy.50.1.87 CrossRefGoogle Scholar
Nederlof, M., Benschop, T.W., de Vries Feyens, C.A. and Heerdink, E.R. (2017). Clozapine re-exposure after dilated cardiomyopathy. BMJ Case Reports, 27, 27. doi: 10.1136/bcr-2017-219652 Google Scholar
Nilsson, L.L. and Logdberg, B. (2008). Dead and forgotten – postmortem time before discovery as indicator of social isolation and inadequate mental healthcare in schizophrenia. Schizophrenia Research, 102, 337–339. doi: 10.1016/j.schres.2008.03.011 CrossRefGoogle Scholar
Purushotham, A., Bains, S., Lewison, G., Szmukler, G. and Sullivan, R. (2013). Cancer and mental health – a clinical and research unmet need. Annals of Oncology, 24, 2274–2278. doi: 10.1093/annonc/mdt214 CrossRefGoogle ScholarPubMed
Rice, T.R., Dobry, Y., Novakovic, V. and Appel, J.M. (2012). The importance of patient-provider communication in end-of-life care. Journal of Bioethical Inquiry, 9, 439–441. doi: 10.1007/s11673-012-9397-4 CrossRefGoogle ScholarPubMed
Riquin, É., Hubault, P., Baize, N., Lhuillier, J.-P. and Duverger, P. (2017). Particularités de l’accompagnement en soins palliatifs d’un patient atteint de schizophrénie en secteur psychiatrique. Annales Médico-psychologiques, revue psychiatrique, 175, 140–145. doi: 10.1016/j.amp.2016.06.003 CrossRefGoogle Scholar
Saxena, S. and Maj, M. (2017). Physical health of people with severe mental disorders: leave no one behind. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 16, 1–2. doi: 10.1002/wps.20403 CrossRefGoogle ScholarPubMed
Shalev, D., Brewster, K.K. and Levenson, J.A. (2017). End-of-life care for patients with schizophrenia #332. Journal of Palliative Medicine, 20, 787–788. doi: 10.1089/jpm.2017.0164 CrossRefGoogle Scholar
Shen, H.-N., Lu, C.-L. and Yang, H.-H. (2011). Increased risks of acute organ dysfunction and mortality in intensive care unit patients with schizophrenia: a nationwide population-based study. Psychosomatic Medicine, 73, 620–626. doi: 10.1097/PSY.0b013e3182280016 CrossRefGoogle ScholarPubMed
Sweers, K., Dierckx de Casterle, B., Detraux, J. and De Hert, M. (2013). End-of-life (care) perspectives and expectations of patients with schizophrenia. Archives of Psychiatric Nursing, 27, 246–252. doi: 10.1016/j.apnu.2013.05.003 CrossRefGoogle ScholarPubMed
Taipale, H. et al. (2018). Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia. Schizophrenia Research, 197, 274–280. doi: 10.1016/j.schres.2017.12.010 CrossRefGoogle Scholar
Taylor, C., Fertal, J.C. and Liao, S. (2018). Refractory schizophrenia, attempted suicide, and withdrawal of life support: a clinical ethics case report. Journal of Pain & Symptom Management, 56, 153–157. doi: 10.1016/j.jpainsymman.2018.02.014 CrossRefGoogle ScholarPubMed
Taylor, E.J., Golas, L., Martel, J.R. and Martel, J.B. (2013). Advanced basal cell carcinoma in a patient with schizoaffective disorder: constraints and management. Ophthalmic Plastic & Reconstructive Surgery, 29, e49–51. doi: 10.1097/IOP.0b013e31826a24cb CrossRefGoogle Scholar
Temel, J.S. et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363, 733–742. doi: 10.1056/NEJMoa1000678 CrossRefGoogle ScholarPubMed
Terpstra, T.L., Williamson, S. and Terpstra, T. (2014). Palliative care for terminally ill individuals with schizophrenia. Journal of Psychosocial Nursing & Mental Health Services, 52, 32–38. doi: 10.3928/02793695-20140522-01 CrossRefGoogle ScholarPubMed
Thienpont, L., Verhofstadt, M., Van Loon, T., Distelmans, W., Audenaert, K. and De Deyn, P.P. (2015). Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open, 5, e007454. doi: 10.1136/bmjopen-2014-007454 CrossRefGoogle ScholarPubMed
Tokuda, Y., Obara, H., Nakazato, N. and Stein, G.H. (2008). Acute care hospital mortality of schizophrenic patients. Journal of Hospital Medicine (Online), 3, 110–116. doi: 10.1002/jhm.256 CrossRefGoogle ScholarPubMed
Tylec, A., Dubas-Slemp, H., Wojcicka, A., Drop, B. and Kucharska, K. (2018). The difficulties of secondary prophylaxis of cervical cancer in women suffering from paranoid schizophrenia – a case study. Psychiatria Polska, 52, 251–259. doi: 10.12740/PP/69142 CrossRefGoogle ScholarPubMed
Vos, T. et al. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet, 388, 1545–1602. doi: 10.1016/S0140-6736(16)31678-6 CrossRefGoogle Scholar
Weiner, E. (2011). Lessons from Jimmy. The American Journal of Psychiatry, 168, 243–244. doi: 10.1176/appi.ajp.2010.10101562 CrossRefGoogle ScholarPubMed
Weir, A.B. (2014). Mutual encounter. American Journal of Hospice & Palliative Medicine, 31, 583–584. doi: 10.1177/1049909113494461 CrossRefGoogle ScholarPubMed
World Health, O. (2018). Integrating Palliative Care and Symptom Relief into Primary Health Care: A WHO Guide for Planners, Implementers and Managers. Geneva: World Health Organization.Google Scholar
Wright, J., Brown, A., McCagg, J.M. and Richmond, B. (2013). Locally advanced squamous cell carcinoma presenting with internal mammary artery hemorrhage. American Surgery, 79, E316–E317.CrossRefGoogle ScholarPubMed
Young, J.M. and Everett, B. (2015). Cause of death: schizophrenia? British Columbia Medical Journal, 57, 434–437.Google Scholar
Supplementary material: File

Baruth et al. Supplementary Materials

Baruth et al. Supplementary Materials

Download Baruth et al. Supplementary Materials(File)
File 17.8 KB