Tsai Shang-Ying, Lee Chao-Hsien, Kuo Chian-Jue, Chen Chiao-Chicy
Department of Psychiatry, Taipei Medical University School of Medicine, Medical University Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan.
J Clin Psychiatry. 2005 Dec;66(12):1586-91. doi: 10.4088/jcp.v66n1215.
Many of the prior mortality studies on bipolar disorder have emerged primarily from the larger health service groups, with a tendency to focus on suicide alone. This study examines personal and clinical characteristics of bipolar patients in Taiwan in order to identify the factors associated with early natural death.
Bipolar patients admitted to a psychiatric hospital in Taiwan between 1987 and 2002 were retrospectively followed through record linkage for cause of death. One living bipolar individual was matched to each deceased patient as a control subject for age, gender, and date of index admission. Clinical data and the results of laboratory examinations during the last period of hospitalization were obtained through a review of medical records.
In a total of 60 natural deaths, the principal cause was circulatory disease (33.3%). Conditional logistic regressions revealed that the variables most strongly associated with natural deaths were years of antipsychotic treatment prior to the last visit (95% CI for odds ratio [OR] = 0.77 to 0.98), serum alanine aminotransferase levels (95% CI for OR = 1.02 to 1.25), and leukocyte counts (95% CI for OR = 1.01 to 2.50). Years of lithium treatment (95% CI for OR = 0.74 to 0.97) may be substituted for antipsychotic treatment as a protective factor.
Systemic inflammation and nonhepatic tissue damage during the acute phase of bipolar disorder may be risk factors for early natural death. Psychiatric treatment, including medication with antipsychotics or lithium, could be a factor in protecting against early natural death.
先前许多关于双相情感障碍的死亡率研究主要来自较大的医疗服务群体，且倾向于仅关注自杀。本研究调查台湾双相情感障碍患者的个人和临床特征，以确定与早期自然死亡相关的因素。
对1987年至2002年期间入住台湾一家精神病院的双相情感障碍患者进行回顾性随访，通过记录链接确定死亡原因。为每位死亡患者匹配一名在世的双相情感障碍患者作为对照，匹配因素包括年龄、性别和首次入院日期。通过查阅病历获取患者最后住院期间的临床数据和实验室检查结果。
在总共60例自然死亡病例中，主要死因是循环系统疾病（33.3%）。条件逻辑回归显示，与自然死亡最密切相关的变量是最后一次就诊前接受抗精神病药物治疗的年限（优势比[OR]的95%置信区间为0.77至0.98）、血清丙氨酸转氨酶水平（OR的95%置信区间为1.02至1.25）和白细胞计数（OR的95%置信区间为1.01至2.50）。锂盐治疗年限（OR的95%置信区间为0.74至0.97）可作为保护因素替代抗精神病药物治疗。
双相情感障碍急性期的全身炎症和非肝脏组织损伤可能是早期自然死亡的危险因素。包括使用抗精神病药物或锂盐在内的精神科治疗可能是预防早期自然死亡进而起到保护作用的一个因素。
