Cardiac surgery for patients with schizophrenia: clinical experience of six patients.

PURPOSE: The incidence of schizophrenia in Japan is 0.7%, which is similar to the worldwide incidence. The mortality rate of patients with schizophrenia is reported to be higher than that of the general population, and cardiovascular disease is high among the causes of death. Hence, strategies for cardiovascular surgery for patients with schizophrenia are necessary. METHODS: We studied six patients with schizophrenia (five males, one female) who underwent cardiac surgery in our hospital between April 2008 and December 2019. RESULT: The mean age was 63.6 years. The surgical procedures were coronary artery bypass grafting (CABG) (n = 4), CABG concomitant with valve procedures (n = 1), and resection of myxoma (n = 1). There were no major cardiovascular complications and no other fatal complications. The mean observation period was 1510.6 ± 1430.1 (140-4068) days, the mean post-operative hospital stay was 17.8 ± 3.5 (13-22) days, and there was no mortality within 30 days after surgery. During the observation period, one patient died. The survival rate was 83.3% at 1, 3, and 5 years. CONCLUSION: Cardiac surgery for patients with schizophrenia is possible with careful monitoring of indications and perioperative management.

Predictors of short-term repetition of self-harm among patients admitted to an emergency room following self-harm: A retrospective one-year cohort study.

We conducted a retrospective chart-review study, examining predictors of the repetition of short-term self-harm (<1 month and <6 months) among the patients who were admitted to an emergency department in Japan following self-harm. A total of 405 patients were enrolled and were followed-up for a subsequent one year. The incidence of repeated self-harm within one- and six- months were 6.4% and 13.1%, respectively. Cox's proportional hazards model analyses demonstrated that history of self-harm and comorbid physical illness were associated with repeated self-harm within one month. The patients who lived alone and who were directly discharged from the emergency room after referral to a psychiatrist were at higher risk for repeated self-harm within both one and six months. Living on public assistance and having been discharged from psychiatric wards within the past 12 months were associated with repetition within six months. These risk factors should be incorporated into routine assessment at an emergency room, and elaborate follow-up plan should be provided to the patients with these risk factors upon discharge from the emergency room. Further prospective studies are warranted, addressing more comprehensive factors that are associated with short-term risk for self-harm and suicide.