抗精神病药物和儿童和年轻人的死亡率
Wayne A Ray1, D Catherine Fuchs2, Mark Olfson3
1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA psychiatry
|November 29, 2023
概括
抗精神病药物剂量超过100毫克克洛普罗马зин相当剂与年轻成年人18-24岁的死亡率增加有关. 较低剂量或在5至17岁儿童中使用,与死亡风险增加没有显著关联.
科学领域:
- 精神病学和药理学 精神病学和药理学
- 公共卫生和流行病学
背景情况:
- 抗精神病药物的剂量相关影响可能会影响儿科和年轻成人群体的死亡率.
- 了解这些风险对于脆弱年龄组的安全有效的精神病治疗至关重要.
研究的目的:
- 在5至24岁的患者中,比较抗精神病和控制精神病药物之间的死亡风险.
- 调查抗精神病药物使用与这一人口群中的死亡率之间的剂量依赖关系.
主要方法:
- 美国一项全国性回顾性队列研究,涉及超过200万5-24岁的医疗补助患者,没有严重的身体疾病或精神病.
- 药物暴露包括第二代抗精神病药物剂量≤100毫克或>100毫克原等效剂与对照药物.
- 根据潜在的死亡原因来评估死亡率,使用基于倾向分数的重叠权重调整分析.
主要成果:
- 抗精神病剂量超过100毫克的普罗马зин等效与增加的总死亡率有关 (RD, 22.4; HR, 1.37),特别是过量和无意伤害死亡.
- 在抗精神病剂剂量≤100毫克或在5-17岁儿童中,没有发现显著的死亡相关性.
- 接受100毫克以上抗精神病剂量治疗的18-24岁的年轻人显示死亡风险明显增加 (RD, 127.5;HR, 1.68).
结论:
- 抗精神病治疗剂量大于100毫克克洛普罗马等效剂与年轻成年人 (18-24岁) 的死亡风险增加有关.
- 较低的抗精神病剂量 (≤100毫克) 或在较小的儿童 (5-17岁) 中使用并没有显示出与死亡率增加的显著关联.
- 这些发现强调了在处方抗精神病药时仔细选择剂量和年龄特定风险评估的重要性.
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