口服葡萄皮质激素和精神病和自杀行为的风险结果:基于人口的队列研究
Tyra Lagerberg1,2, Tapio T Gustafsson3, Yasmina Molero2,4
1Department of Psychiatry, Warneford Hospital, University of Oxford, UK.
概括
葡萄糖皮质醇治疗增加了严重精神病的风险,包括新的或复发的情绪和焦虑障碍. 然而,该研究发现,在使用葡萄糖皮质醇时,与自杀行为没有明确的联系.
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:
- 葡萄糖皮质类药物是被广泛处方的药物.
- 在大规模研究中,将葡萄糖皮质醇使用与精神病和自杀行为联系在一起的证据有限.
- 需要关于与葡萄糖皮质醇治疗相关的严重不良结果的可靠观察数据.
研究的目的:
- 调查口服葡萄糖皮质体治疗与精神病和自杀行为结果之间的关联.
- 在葡萄糖皮质醇治疗期间量化特定精神疾病和自杀行为风险.
- 在患有或没有自身免疫性疾病的个体中探索这些关联.
主要方法:
- 一项大型瑞典基于人口的队列研究 (n=1,105,964) 针对15-54岁的个人 (2006-2020年).
- 考克斯的比例危险模型被用来比较个体在治疗期间和治疗期间之外的结果率.
- 针对性试验模拟用于比较具有和没有自身免疫性疾病引发葡萄糖皮质醇的个体的结果.
主要成果:
- 观察到抑郁症 (HR 1.08),双相情感 (HR 1.23) 和焦虑症 (HR 1.25) 的风险增加.
- 葡萄糖皮质醇使用与自杀行为之间没有明确的关联 (HR 1.06).
- 风险在治疗的前几周升高,在患有精神疾病的患者中更高;在自身免疫性疾病患者中,相关性减弱.
结论:
- 口服葡萄糖皮质激素治疗与严重精神病的风险更高,包括新发作和复发的常见精神疾病.
- 这些发现表明,在葡萄糖皮质醇治疗期间,有精神疾病病史的个人可能需要更密切的监测.
- 虽然精神病风险较高,但该研究没有发现与自杀行为有显著的关联.
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