Complicated Appendicitis More Likely Among Patients With Psychiatric Disorders

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.

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.”

This article originally appeared on Psychiatry Advisor