Schizophrenia affects approximately 1% of the US population. This serious psychiatric illness is characterized by psychotic symptoms (hallucinations and delusions), cognitive symptoms (difficulties with attention, memory, and decision making), and negative symptoms (withdrawn behavior, low speech output and content, and diminished motivation).

Although there is no cure for schizophrenia, treatment can decrease symptoms. Currently, these treatments include medications and psychosocial interventions. Many individuals with schizophrenia can work, live independently or with limited assistance, and enjoy life. Unfortunately, some individuals have symptoms that do not respond to treatment and interfere with their ability to lead independent lives and comply with treatment.

Persons with schizophrenia have a greatly diminished life span. In general, people with this disorder die more than 25 years earlier than the general population. In other words, these individuals can only expect to live about 70% of the normal life span. Why do they die early?

In a paper recently published in JAMA Psychiatry, Mark Olfson and colleagues set out to answer this question. They examined reasons for premature mortality in a group of over 1 million people with schizophrenia covered by Medicaid, the largest insurance provider for persons suffering from schizophrenia in the U.S. They identified causes of death for over 65,500 of the 74,000 people who died during the study period and found that individuals with schizophrenia had an increased rate of death across all ages and all demographic groups when compared to the general population. 

What were the causes of death in these individuals? Olfson and colleagues found that both natural causes and unnatural causes of death were increased by over three-fold. The most common causes of death were cardiovascular disease, cancer (particularly lung cancer), diabetes, influenza, accidental deaths, and suicides. The large majority of deaths (almost 55,750) resulted from natural causes. However, the rates of death from suicide and accidents were also substantially elevated.

Smoking is a significant risk factor for a number of diseases on this list. It has been known for a long time that a large majority of persons with schizophrenia smoke. In fact, the rate of smoking for individuals with schizophrenia is more than twice the rate observed in individuals without schizophrenia. Many are also very heavy smokers. This increased rate of smoking accounts for some of the increased death rate, but not all of it.

Can something be done to decrease premature death in people with schizophrenia? Helping individuals stop smoking would greatly improve life expectancy. Premature deaths from cardiovascular disease can also be reduced by treating high blood pressure and high cholesterol levels. The effects of diabetes and cardiovascular disease can also be diminished by regular exercise, eating right, and, in those who are obese, weight loss.

Health care professionals should routinely screen for suicidality, depression, and use of alcohol and other drugs of abuse, and recommend treatment when appropriate. Encouraging individuals to minimize their use of alcohol and marijuana may lead to a decrease in accidental deaths and deaths from suicide. Treatments for drug addiction can help a number of individuals avoid premature death.

Although implementing the above recommendations may be a challenge in persons with psychotic illnesses, such treatment programs can and do work in this population. Investing in educational and psychosocial resources will save lives. It is important that families and friends of people living with schizophrenia not give up and continuously encourage their loved ones to engage in programs that include smoking cessation, drug cessation, exercise, healthy eating, maintenance of healthy body weight, and control of high blood pressure and high cholesterol.

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.

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