Risk of acute pancreatitis among people with severe mental illness

Mathew Vithayathil , Chin-Kuo Chang, Hitesh Shetty, Robert James Stewart

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Abstract

Severe mental illness (SMI) encompasses schizophrenia, schizoaffective disorder, and bipolar affective disorder, and is recognised to be associated with higher risks of physical morbidity and mortality(Chang et al., 2011). Mortality in this group has been found to be 2-3 fold higher than general population estimates, including both natural and unnatural causes of death(Brown et al., 2010), resulting in a substantial reduction of 15-20 years in life expectancy. Increased risk of physical co-morbidities in people with SMI has been described for cardiovascular, respiratory and gastrointestinal diseases(Carney and Jones, 2006, Carney et al., 2006). However, most research interest has been focused on cardiovascular and metabolic disorders(Taylor and MacQueen, 2006), and there is a pressing need for further characterisation of health risks in order to develop and target prevention strategies against adverse health outcomes(Chang, 2012).
Acute pancreatitis is the leading cause of gastroenterological hospitalisations. In the UK, the hospitalisation rate for acute pancreatitis is 9·8 per 100,000 per year(Goldacre and Roberts, 2004), and is associated itself with significant morbidity and mortality(Dervenis et al., 1999). Patients with acute pancreatitis have an increased risk of further reoccurrence, with 10% progressing to chronic pancreatitis(Yadav et al., 2012).
The most common risk factors for acute pancreatitis are gallstones and acute excessive alcohol intake, with idiosyncratic drug reactions to multiple medications also described(Jones et al., 2015). Furthermore, aging and Afro-Caribbean ethnicity group are risk factors for the disease(Yadav and Lowenfels, 2013). Alcohol excess is the second most common cause of acute pancreatitis after gallstones(Yadav and Lowenfels, 2006). People with SMI have been found to have an increased risk of alcohol use disorder (AUD), demonstrated both in schizophrenia and bipolar affective disorder (Carney and Jones, 2006, Carney et al., 2006). However to date no study has investigated the risk of acute pancreatitis in people with SMI. Through a large retrospective cohort analysis and a nested case-control study we therefore sought to characterise the risk of hospitalisation with acute pancreatitis in people with SMI, with particular focus on the influence of co-morbid AUD.
Original languageEnglish
JournalJournal of Affective Disorders
Publication statusAccepted/In press - 10 Nov 2019

Keywords

  • pancreatitis
  • severe mental illness
  • Case register
  • schizophrenia
  • schizoaffective disorder
  • bipolar affective disorder

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