Complicated Appendicitis More Likely Among Patients With Psychiatric Disorders

Fewer patients with complicated appendicitis had no psychiatric disorders compared with patients without complicated cases.

Patients with severe psychiatric disorders may be at risk for complicated appendicitis, according to results of a study published in BMC Psychiatry.

Data for this study were sourced from 4 hospitals within South Korea that were part of the Observational Medical Outcomes Partnership common data model. Patients (N=47,518) with acute appendicitis between 2002 and 2020 were evaluated for complications on the basis of having a mental health diagnosis. Complicated appendicitis was defined as peritonitis, perforation, or abscess.

The study population included patients aged ≤14 years (20.89%), 50.82% were boys or men, and 98.25% had no psychiatric disorders.

A total of 8158 patients had complicated appendicitis. Fewer patients with complicated appendicitis had no psychiatric disorders compared with patients without complicated cases (97.72% vs 98.36%), respectively.

Medical personnel should remain alert to the possibility that serious, potentially life-threatening physical conditions occur in patients with psychotic and bipolar disorders, who infrequently present with pain symptoms.

Among the 212 patients with complicated appendicitis who had a psychiatric disorder, the most common conditions were depressive disorders (40.6%), psychotic disorders (13.2%), and bipolar disorder (6.60%).

Risk for complicated appendicitis was associated with 55 to 64 years (adjusted odds ratio [aOR], 2.379; 95% CI, 1.168-4.849), 65 to 74 years (aOR, 2.909; 95% CI, 1.618-5.232), or ≥75 years of age (aOR, 4.275; 95% CI, 2.323-7.868); bipolar disorder (aOR, 2.323; 95% CI, 1.194-4.520); and psychotic disorder (aOR, 1.951; 95% CI, 1.218-3.125).

Stratified by psychotropic drug use, compared with no use, risk for complicated appendicitis was associated with high-dose antipsychotic use for less than 1 year (aOR, 1.1896; 95% CI, 1.077-3.338) or 2 to 5 years (aOR, 1.930; 95% CI, 1.144-3.256) and with compliance to antipsychotics at a rate of <0.8 (aOR, 1.664; 95% CI, 1.014-2.732) or ≥0.8 (aOR, 1.437; 95% CI, 1.074-1.922).

The results of this study may have been biased, as some mood stabilizers can affect pain sensitivity, and it remains unclear whether alterations to pain perceptions played a role in complication risks.

Study authors concluded, “This study revealed a close relationship between the risks of complicated appendicitis and psychiatric disorders, including psychotic and bipolar disorders. […] Medical personnel should remain alert to the possibility that serious, potentially life-threatening physical conditions occur in patients with psychotic and bipolar disorders, who infrequently present with pain symptoms.”

References:

Kim J, Yang C, Joo HJ, et al. Risks of complicated acute appendicitis in patients with psychiatric disorders. BMC Psychiatry. 2022;22(1):763. doi:10.1186/s12888-022-04428-7