Follow Up on Smoking and Serious Mental llness and Psychiatry in Scandinavia

By Marvin Ross with an addendum by Dr David Laing Dawson

My blog on smoking turned out to be one of the most widely read blogs that we’ve done. I had made the point that people with schizophrenia have a shortened life expectancy of about 20 years compared to a shortened life expectancy from smoking of about 10 years. One of the reasons for the shortened life expectancy not involving smoking is the poor medical preventive care that these people receive from the health system.

Of course, there are those who argue that the treatment for schizophrenia – prescription medication – is a leading cause of death. I’ve just come across a paper from Sweden on real life mortality in a cohort of close to 30,000 patients. Data was collected on the period from 2006 to 2013 on all cause mortality among those with schizophrenia aged 16-64.

What the study found was that the use of long acting injecting anti-psychotics resulted in a mortality that was 30% lower than that for oral agents. Long acting paliparidone turned out to have the lowest mortality followed by oral aripiprazole. However, the use of any antipsychotics resulted in less mortality than not taking them. So much for the anti-medication faction who, in my opinion, have a great deal in common with anti-vaxxers.

My blog on open dialogue and the medication free units in Norway also resulted in a number of comments. Hakon Heimer pointed out that a recent article in Psychiatry Online found that “The present data on Open Dialogue are insufficient to warrant calls for further research on the program other than those projects that are currently under way.” The editorial on the research of Open Dialogue stated that “Unfortunately, the results of this review are underwhelming.”

Heimer is founder, project director, and executive editor of Schizophrenia Research Forum, an online knowledge environment for researchers, which is part of the Brain and Behavior Research Foundation. He also advises the National Institute of Mental Health in the US.

And then, I received this:

Linking up the mind emotions abuse illness and recovery

what a piece of dirt article , where is the bin, , how can anyone even accept the current system unless you a child abuser yourself… that all mentallness comes from and what the psychiatrist see all day, and then go hunting brain cells for 50 years and not do a thing,,,, if im wrong, show me or fuck of you bit of filth, or comment, the bomb is ready to blow, the troop are getting in place and the abusers just keep on abusing cause thats what abuse does

Not the first time I’ve had something like this nor will it be the last.


Some other factors supporting these conclusions, including the lowest mortality being found with bi-weekly or monthly injections (vs pills):

Non adherence with oral antipsychotics is high. Depending on the definition of non-adherence, it is found in studies to be 20 to 40%, and underestimated by psychiatrists.

Non adherence with antipsychotic treatment results, for people suffering from schizophrenia, in higher rates of:

  • relapse
  • re-hospitalization
  • emergency visits
  • violence
  • being victims of violence and other crimes
  • arrest
  • incarceration
  • homelessness
  • suicide
  • Inattention to other health matters.

Thus the striking improvement in mortality with injectable antipsychotic medication could be simply attributed to improved compliance with pharmacological treatment.

However, non-compliance with all medications is a major problem. According to one study, about 1/3 of patients do not take all the pills they are prescribed while another 1/3 do not take what is prescribed at all.

4 thoughts on “Follow Up on Smoking and Serious Mental llness and Psychiatry in Scandinavia

  1. A great article Marvin, and good timing. If I read it correctly, long acting injectable paliperidone increases life span for people suffering from schizophrenia. At the moment, we are trying to encourage my loved one to accept injections. Your article will give us another good reason to use in trying to persuade him. Fingers crossed!


  2. “I had made the point that people with schizophrenia have a shortened life expectancy of about 20 years”

    Why do I personally not remotely care about that? Makes me wonder…

    Of course I’m not alone on earth, so my opinion is only worth what it’s worth. But I’d like schizophrenia patients to make themselves a retrospective judgement call on whether they want to live 20 more years trapped in the psychiatric system, or whether or not they want something else out of life.

    But I’ll never let family members hijack the expression of the patients themselves. Period.

    People ought to think harder about what medical ethics are all about. Medical ethics should not be about overriding the wishes of patients with the wish of their parents.

    That should be obvious to anyone.


    1. And you F68.10 should think more about about the ethics of leaving someone untreated who loses all control because they are trapped by delusions and hallucinations Treatment gives them a chance of gaining some control.


      1. I’ve been thinking about it for 15 years and I have quite an understanding of the topic. Here’s a paper on that.

        I have some major issues with this paper. Is it not a paper about ethics and psychosis?

        Have I not reflected?

        But I’ll stick to this claim: “But I’ll never let family members hijack the expression of the patients themselves. Period.”


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