Speaker
Description
Abstract
Background:
Mental illness encompasses a range of disorders affecting cognition, mood, and behavior, with significant implications for public health. Globally, around 970 million individuals are affected, with women disproportionately impacted. In Ghana, mental illness affects an estimated 13% of the population and is the second leading cause of years lived with disability. Recent evidence suggests a strong association between mental illness and hemostatic abnormalities, including hypercoagulability, impaired fibrinolysis, and increased thrombotic risk. Psychotropic medications and physical restraint practices further contribute to this risk. Despite these findings, limited data exist on the prevalence and mechanisms of hemostasis abnormalities among psychiatric patients in Ghana.
Aim:
This study sought to determine the prevalence of hemostatic abnormalities among individuals with mental illness in Ghana, identify perturbed coagulation pathways, and evaluate their association with psychiatric diagnoses, treatment medications, and patient management practices such as restraint and sedation.
Methods:
A hospital-based prospective case-control study was conducted at Ankaful Psychiatric Hospital involving 100 participants—50 psychiatric patients and 50 age- and sex-matched healthy controls. Coagulation markers including Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), D-dimer, Plasminogen Activator Inhibitor-1 (PAI-1), Protein C, Protein S, and Antithrombin III were analyzed, alongside complete blood count indices. VTE risk was assessed using the Caprini Risk Assessment Model. Statistical tests included chi-square, logistic regression, ANOVA, and Kruskal-Wallis H tests, with significance set at p ≤ 0.05.
Results:
Sociodemographic analysis revealed significant differences between cases and controls in gender, age, marital status, occupation, and the presence of swollen legs (p < 0.001). Cases had significantly higher BMI (26.9 ± 3.7 vs. 23.8 ± 3.0; p < 0.001), lower RBC parameters (RBC, HGB, HCT; p < 0.001), and decreased platelet indices (PLT, PCT, P-LCC; p < 0.001), indicating possible anemia and thrombocytopenia. Granulocyte percentages were elevated (p < 0.001), while lymphocyte counts were reduced in cases (p < 0.001), suggesting inflammatory or immune activation.
Coagulation analysis showed significantly prolonged PT (13.8 ± 1.9 vs. 12.6 ± 2.0; p = 0.003) and APTT (50.5 ± 8.9 vs. 45.7 ± 7.0; p = 0.004) in cases. D-dimer and PAI-1 levels were markedly elevated among psychiatric patients (p < 0.001), while Antithrombin III was also higher (p = 0.02). No significant differences were observed in Protein C (p = 0.99) or INR (p = 0.31).
One-way ANOVA showed significant group differences in APTT (F(4,95) = 3.215, p = 0.016), with Tukey post hoc tests indicating significantly higher APTT in individuals with schizophrenia compared to controls (p = 0.012). Other coagulation parameters (PT, INR, Protein S) did not vary significantly across diagnostic groups. Similarly, Kruskal-Wallis tests revealed no significant differences in D-dimer, PAI-1, Protein C, or Antithrombin III across different psychiatric conditions.
Conclusion:
This study demonstrates a high prevalence of hemostatic abnormalities among individuals with mental illness in Ghana, characterized by elevated procoagulant and antifibrinolytic markers. These findings suggest increased thrombotic risk, particularly among patients with schizophrenia. Routine coagulation screening and thromboprophylaxis considerations may be warranted in psychiatric care to mitigate potential complications.