Clinical Characteristics, Comorbid Medical Diagnoses, and Causes of Death of Individuals with Severe Mental Illness Who Died During Follow-up in Community Mental Health Centers: A Multicenter, Retrospective Study. / Toplum Ruh Sagligi Merkezlerinde Takipleri Sirasinda Ölen Siddetli Ruhsal Hastaligi Olan Bireylerin Klinik Özellikleri, Ek Tibbi Tanilari ve Ölüm Nedenleri: Çok Merkezli, Geriye Dönük Bir Arastirma.

OBJECTIVE: In this study, it was aimed to define the clinical characteristics, causes of death, disease and treatment of patients who died while being followed for severe mental illness. METHOD: The study was carried out in ten community mental health centers from six provinces. The clinical characteristics, causes of death, course of the illness and treatment characteristics of the patients who had a death report from the date the community mental health centers were opened until the start date of the study were analyzed by retrospective file scanning method. RESULTS: In an average of 52 months, files of 3715 patients were examined. There were death declarations for 106 patients. The diagnosis of most patients with death declarations was schizophrenia (78%), most of them were male (66%), mean age was 57, mean disease duration was 24 years. The rate of multiple antipsychotic medication use was 61%. The most common comorbidities were metabolic syndrome (36%), hypertension (22%), diabetes (18%) and chronic obstructive pulmonary disease (15%). The most frequently reported causes of death were cardiovascular diseases (39%), infectious diseases (14%) and cancer (11%). CONCLUSION: Individuals with severe mental illness followed up in community mental health centers are mostly die due to preventable natural causes of death. Therefore, a sensitive approach should be taken to evaluate psychiatric and other medical conditions together. In our country, there is a need for natural follow-up studies investigating the average age of death and causes of death of individuals with severe mental illness.

Accelerated hypertension after venlafaxine usage.

Venlafaxine is the first antidepressant that acts via inhibiting serotonin and noradrenaline reuptake. Hypertension is observed in doses exceeding 300 mg/day and is the most feared complication. We report a patient with accelerated hypertension after venlafaxine use observed at a dose of 150 mg/day. A 23-year-old patient with symptoms of insomnia, depression, anhedonia, fatigue admitted our clinic. Venlafaxine at a dose of 75 mg/day was initiated after he was diagnosed with major depressive disorder. After 5 months, venlafaxine dose was uptitrated to 150 mg/day due to inadequate response to drug. After using venlafaxine for ten months at the dose of 150 mg/day, he admitted our clinic with headache and epistaxis. He was hospitalized after his blood pressure was measured as 210/170 mmHg. No secondary causes for hypertension were found, and venlafaxine treatment was considered possible etiologic factor. After stopping venlafaxine treatment, his blood pressure was reverted back to normal limits. While mild elevation of blood pressure could be observed after venlafaxine treatment, this case shows that accelerated hypertension with a diastolic blood pressure rise above 120 mmHg could be observed at relatively low doses of venlafaxine. Close monitoring of blood pressure is necessary after initiation of treatment, as accelerated hypertension could cause endorgan damage with potentially catastrophic results.