P262 Outcomes in patients with schizophrenia admitted under gastroenterology

Introduction

Schizophrenia is a severe mental illness which can have a devastating impact on all aspects of an individual’s life. Substance misuse (in particular alcohol), risk of suicide, and high rates of often poorly controlled physical health conditions, have resulted in patients having a life expectancy which is reduced by approximately 15 years when compared to the general population. We aimed to determine the burden of gastrointestinal diseases amongst patients with schizophrenia through consideration of those admitted to the Centre for Liver and Digestive Disorders (CLDD) at the Royal Infirmary of Edinburgh.

Methods

All patients admitted to the CLDD with a diagnosis of schizophrenia (ICD-10 F20) for >24 hours between 01/01/08 and 31/12/21 were identified. Case record review was performed, and clinical and demographic data were collected. The Mann Whitney U test was used to compare continuous variables and the Chi-square test compared categorical variables.

Results

In total 40 patients with schizophrenia were admitted to the CLDD between 01/01/08 and 31/12/21. 57.5% (n=23) were male and the median age on admission was 51.5 years (interquartile range (IQR) 45.8-63.0). The most frequent reasons for admission were gastrointestinal bleeds (35.0%, n=14) and decompensated cirrhosis (20.0%, n=8). 42.5% (n=17) of patients had a background of cirrhosis and there was a history of alcohol excess in 60.0% (n=24). 47.5% (n=19) of patients were anaemic on admission (27.5% (n=11) normocytic, 10.0% (n=4) microcytic and 10.0% (n=4) macrocytic). 22.5% (n=9) of patients had at least one subsequent admission to the CLDD, a median of 4.0 months (IQR 1.0-12.0) after discharge from the index admission. 50.0% (n=20) did not attend at least one booked gastroenterology outpatient appointment after admission. At time of follow-up (a median of 9.0 years (IQR 5.0-11.3) following admission) 55.0% (n=22) of patients were deceased. Deaths occurred a median of 11.5 months (IQR 3.0-36.8) after index discharge; median age at death was 55.0 years (IQR 47.5-67.5). Death was significantly associated with an index admission due to decompensated cirrhosis (p=0.039) and a history of cirrhosis (p=0.019).

Conclusions

Our study has demonstrated a high prevalence of chronic liver disease and alcohol excess amongst those with schizophrenia admitted to the CLDD. The premature mortality rate is in accordance with previous studies on patients with schizophrenia. While case-control studies are required, the lack of compliance amongst a large proportion of patients with outpatient gastroenterology appointments suggests that more support should be in place to encourage attendance amongst this vulnerable population at such a high risk of co-morbidities and mortality.