The finding:
Compared to patients with schizophrenia who did not have viral hepatitis, patients with schizophrenia and viral hepatitis had a higher incidence of severe hepatic outcomes (SHO)— liver failure/decompensation, liver transplantation or liver cancer. Hepatitis C Virus (HCV) HCV was more commonly associated with SHO than Hepatitis B. Most SHOs were developed within 5 years of the diagnosis of schizophrenia.

Strength and weaknesses:
The use of a nationwide population-based cohort and longitudinal follow up in a system in a unified database are strengths of the study. The diagnosis of schizophrenia was made after either a hospitalization or at least 3 clinic visits. Limitations include lack of availability of biomarkers such as hepatic enzymes or viral load and an inability to account for the presence of other hepatotoxic medications besides antipsychotics. While not a limitation, it is noteworthy that this study was conducted in Taiwan, which has a national program for combatting HBV infections, and the timeline of data collection (between 2002-13) limits the available antiviral medications for HCV.

Relevance:
The prevalence of viral hepatitis is higher in patients with schizophrenia compared to the general population, but data for longitudinal morbidity were lacking. Not only are patients with schizophrenia at higher risk for HBV and HCV infections, but they also experience more serious morbidity stemming from infection than the general population. Studies have previously shown that patients with schizophrenia may display less health-seeking behaviour, have greater co-morbid substance use, and face disparity of health outcomes. It is important for C-L psychiatrists to be informed of these risks, as early detection of hepatitis after a diagnosis of schizophrenia could be of great impact given that a majority of the SHOs were noted within 5 years. These findings could also contribute to an additional aspect of risk to be considered during liver transplant evaluations.

Type of study (EBM guide):
Cohort study