Two papers I shouldn't want to read when looking for stuff on clozapine

It's papers like this that justify the use of antipsychotic medication using the best science available.

This is an observational study by a Finnish professor that prompted calls for clozapine to become a first line treatment. Ugh.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60742-X/abstract
11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study)
(full paper available here)

Here's another one showing the mortality risk
A Systematic Review of Mortality in Schizophrenia
Is the Differential Mortality Gap Worsening Over Time?
Sukanta Saha, MSc, MCN; David Chant, PhD; John McGrath, MD, PhD, FRANZCP
Arch Gen Psychiatry. 2007;64(10):1123-1131.
http://archpsyc.ama-assn.org/cgi/content/abstract/64/10/1123

If you want a simplified summary of these papers there's more info at the NHS National Prescribing Centre blog
Antipsychotic use and life expectancy of people with schizophrenia
http://www.npci.org.uk/blog/?p=423

Unfortunately they seem to have missed out a detail from the Saha review abstract
"
Conclusions 
With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention.
"

It seems the American researchers are more aware of the effects of antipsychotic on morbidity and mortality separate from treating the suicide rate. The 2007 review's recommendation in the abstract (I'll get round to reading the full paper) is a good one, and I think it's somewhat done through the regular health checks that were stipulated in NICE's schizophrenia guidelines 2009. I think it's stuff like that which is why Rethink asked their campaigners to ask local PCTs to comply with NICE's guidelines (which isn't happening a year on since they were published).

In practice optimising the general health of people with schizophrenia may not be something I agree with. I assume it would involve a lot of behavioural modification or lifestyle changes that individual's preferring to make their own choices about their lifestyle wouldn't accept. That's current mental healthcare practice though. There's no reason why modern mental health care couldn't be improved to listen to what people with a diagnosis of schizophrenia want when it comes to behavioural modifcation to help them live longer then work with them rather than against them which is what can happen for a lot of people with severe mental illnesses.

The reason why I want to read the Finnish study (which I've read before) is because it has the data I want. The result is crushing to me of course because it's a bloody great piece of evidence. The author looked at a huge sample of the population in a purely quantitative analysis way. He defined mortality as all-cause deaths. What that means is he didn't differentiate between death by suicide and death by other causes. In my opinion suicide death is different from other forms of death. It would be useful to see the effect on suicide and the effect on other forms of mortality separated out by the different antipsychotics studied. I think there would be some surprising results but I wouldn't even dare to guess at what they were.

Basically what I'm trying to do is find a study somewhere that can actually separate out the lifestyle factors that lead to death and reduced life expectancy, the suicides and the influence on antipsychotic medcation on life expectancy. From the little bit of data I've had on the number of people taking clozapine for a long time and dying prematurely without killing themselves is quite high for the small number of people taking clozapine. I've already identified a number of other potential clozapine-induced factors that can lead to reduced life expectancy and death but it's just a list rather than a piece of evidence that directly says clozapine causes (a significant and measured or estimated) reduced life expectancy separate to clozapine-induced agranulocytosis and neuropenia. Hmm...perhaps I should read a book by Peter Breggin or something.