在接受机械通风的非手术重症患者中,精神病诊断和精神活性药物的使用
Hannah Wunsch1, Christian F Christiansen2, Martin B Johansen3
1Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
JAMA
|March 20, 2014
概括
危急病患者有较高的先前精神病诊断率. 幸存者面临着新精神病诊断和退院后药物使用的暂时增加风险.
科学领域:
- 关键护理医学 关键护理医学
- 精神病学是一个精神病学.
- 流行病学 流行病学
背景情况:
- 危急疾病和精神疾病之间的联系尚未得到充分理解.
- 在危急疾病发生之前和之后调查精神健康对于患者护理至关重要.
研究的目的:
- 评估精神病诊断和精神活性药物处方在危急疾病之前的几年.
- 评估严重疾病后一年内新精神病诊断和药物使用的发生率.
主要方法:
- 丹麦的一个基于人口的队列研究 (2006-2009) 包括重症患者 (通过机械通风进入重症监护室) 和匹配的对比队列.
- 疾病前的精神病诊断和药物使用使用调整的流行率比率 (PRs) 进行了比较.
- 新诊断和药物使用后临界疾病使用累积发病率和通过考克斯回归调整的危险比率 (HRs) 进行评估.
主要成果:
- 与住院 (5.4%) 和一般人口 (2.4%) 队列相比,重病患者的先前精神病诊断率 (6.2%) 较高.
- 退院后,没有先前精神病史的重病幸存者在3个月内增加了新诊断 (0.5%vs0.2%) 和药物处方 (12.7%vs5.0%) 的风险.
- 这些增加的风险在放免费后的9-12个月内在很大程度上得到解决.
结论:
- 以前存在的精神疾病在重症患者中更为普遍.
- 危急疾病幸存者经历了新的精神病诊断和精神活性药物使用的暂时上升.
- 这些发现表明精神疾病的潜在诱导作用和疾病后过渡性精神风险.
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