Cancer mortality among elderly patients with brief psychotic disorder

The death rates among psychiatric patients have been reported to be higher when compared to those of the general population (Jorgensen and Mortensen, 1990; Saku et al., 1995). However, the cancer mortality has even been lower or higher in these patients than that in general population (Saku et al., 1995). The psychiatric diagnosis, the selection of the patients and the type of cancer may contribute to this discrepancy (Craig and Shang, 1981). Patients, admitted for the first time for reactive psychosis have higher mortality in general (Jorgensen and Mortensen, 1990). This was highest in young patients and in the first few years following the psychotic episode. Accordingly, in some other studies excess mortality in patients with reactive psychosis has been suggested (Andersen and Laerum, 1980). Odegaard, however, reported lower relative mortality in patients with reactive psychosis than with schizophrenia or manic-depressive psychosis (Odegaard, 1967). In this study the mortality from cancer was 2–3.5 times higher in patients with organic psychoses than in other psychoses or in general population (Odegaard, 1967). According to one report, patients with reactive psychosis have increased cancer mortality (Saku et al., 1995). The focus of the present study is to search for a relationship between psychiatric diagnosis and cause of death. In the present study all 150 patients successively admitted to the psychogeriatric clinic (Tampere University Hospital) during a one-year period between July 1986 and June 1987 were included in this follow-up study. The patients admitted were medically carefully examined (computer tomography of head, EEG, blood chemistry, haematology) in addition to undergoing neuropsychological tests. Psychiatric diagnoses were constituted according to the criteria of DSM-III-R. Fifteen of these patients were lost during the follow-up for various reasons. Thus, 135 patients were followed up until death or for 10 years. One hundred and seven of the patients were women and 28 were men, their ages varied between 65 and 88 years (74.77 6.15, mean SD). The causes of death were based on the case records and death certificates. Logistic regression analysis (including gender and age) was used to study the relationship between psychiatric diagnosis and cause of death. Thirteen of the 135 patients fulfilled the criteria of brief reactive psychosis, no organic causes were shown. Six of these patients (43%) died later from cancer whereas only eight of the remaining 122 (7%) died of cancer (Odds ratio 7.3, 95% Confidence intervals 1.95–27.44, p< 0.001). Brief psychotic disorder was the only significant variable in the analysis. Gender (p1⁄4 0.947) and age ( p1⁄4 0.246) did not have any influence on this result. The basic data of these patients are presented in Table 1. In this study we report a significant increase in cancer mortality in elderly patients who were admitted to psychogeriatric clinic for first time for brief reactive psychosis. The mortality seemed to be highest three to four years after the index treatment. The present study supports the results of Saku and coworkers in which patients with brief reactive psychosis also had higher cancer mortality than the other psychiatric patients (Saku et al., 1995). The present results, however, hardly concur with those of Odegaard, who showed that the mortality from cancer was 2–3.5 times higher in patients with organic psychoses than those with other psychoses or general population (Odergaard, 1967). Comparison between this and the present study, however, is difficult because of the diagnostic differences. On the basis of the present results we concluded that a patient first suffering brief reactive psychosis in old age may have an increased risk of contracting cancer during the next few years. We therefore