Müller-Oerlinghausen Bruno, Berghöfer Anne, Ahrens Bernd
Freie Universität, German Medical Association, Cologne-Berlin, Germany.
Can J Psychiatry. 2003 Aug;48(7):433-9. doi: 10.1177/070674370304800702.
The suicide-related mortality among patients with affective disorders is approximately 30 times higher, and overall mortality 2 to 3 times higher, than suicide-related mortality in the general population. Lithium has demonstrated possibly specific antisuicidal effects apart from its prophylactic efficacy: it significantly reduces the high excess mortality of patients with affective disorders. To date, suicide-prevention effects have not been shown for antidepressant or anticonvulsant long-term treatment. Clozapine appears to reduce the suicide rate in schizophrenia patients. Against this background, guidelines and algorithms for selecting an appropriate prophylactic strategy for affective disorders should consider the presence of suicidality in patient history. Appropriate lithium prophylaxis prevents approximately 250 suicides yearly in Germany, although lithium salts are infrequently prescribed within the National Health Scheme (specifically, to 0.06% of the population). Rational treatment strategies most likely would demand that prescription rates be about 10 times higher.
情感障碍患者的自杀相关死亡率比普通人群高出约30倍，总体死亡率高出2至3倍。除了预防功效外，锂还显示出可能具有特定的抗自杀作用：它能显著降低情感障碍患者极高的额外死亡率。迄今为止，抗抑郁药或抗惊厥药的长期治疗尚未显示出预防自杀的效果。氯氮平似乎能降低精神分裂症患者的自杀率。在此背景下，为情感障碍选择合适预防策略的指南和算法应考虑患者病史中是否存在自杀倾向。在德国，适当的锂预防措施每年可预防约250例自杀，尽管锂盐在国家卫生计划中的处方量很少（具体而言，仅占人口的0.06%）。合理的治疗策略很可能要求处方率提高约10倍。
