精神分裂症患者的药物暴露和死亡率
Sébastien Brodeur1,2, Yohann M Chiu3,4, Josiane Courteau4
1Département de Psychiatrie et Neurosciences, Université Laval, Québec City, Québec, Canada.
JAMA network open
|November 22, 2024
概括
纠正不朽时间偏差 (ITB) 显示,高剂量的抗精神病药物和二类药物与精神分裂症患者的死亡率增加有关. 高剂量的抗抑郁药在ITB纠正后显示死亡风险降低.
科学领域:
- 精神病学是一个精神病学.
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 抗精神病药物,抗抑郁药和二二类药物通常用于精神分裂症治疗.
- 关于药物相关死亡风险的观察性研究往往忽略了不朽时间偏差 (ITB).
- 忽视ITB可能导致误解药物对精神分裂症死亡率的影响.
研究的目的:
- 调查抗精神病药物,抗抑郁药和二二类药物的累积剂量与精神分裂症患者的死亡风险之间的关联.
- 评估不朽时间偏差对这些关联的影响.
- 为了更准确地了解精神分裂症的药物安全性.
主要方法:
- 一项利用加拿大北克省 (2002-2012) 的行政数据进行的队列研究.
- 包括被诊断患有精神分裂症的17-64岁患者.
- 分析2013-2017年所有原因的死亡率,使用考克斯比例危险回归模型,比较时间固定的和时间依赖的 (ITB校正) 暴露方法.
主要成果:
- 高剂量的抗精神病药物使用与ITB纠正后的死亡率增加有关 (AHR,1.28).
- 高剂量抗抑郁药的使用显示,在ITB纠正后,死亡风险降低 (AHR,0.86).
- 类药物始终与死亡风险增加有关,不论分析方法如何.
结论:
- 纠正ITB对于准确评估药物对精神分裂症死亡率的影响至关重要.
- 高剂量的抗精神病药物使用可能比先前估计的死亡风险更高.
- 抗精神病药物的长期死亡益处需要根据ITB重新评估.
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