Kales Helen C, Valenstein Marcia, Kim H Myra, McCarthy John F, Ganoczy Dara, Cunningham Francesca, Blow Frederic C
Serious Mental Illness Treatment Research and Evaluation Center, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Ann Arbor, MI 48109, USA.
Am J Psychiatry. 2007 Oct;164(10):1568-76; quiz 1623. doi: 10.1176/appi.ajp.2007.06101710.
Mortality rates in the year following new antipsychotic medication starts for neuropsychiatric symptoms of dementia were compared with rates after starts of other psychiatric medications.
The retrospective, cohort study used national data from the Department of Veterans Affairs (fiscal years 2001-2005) on patients older than 65 years who began outpatient treatment with psychiatric medication following a dementia diagnosis (N=10,615). Twelve-month mortality rates were compared in patients taking antipsychotics and those taking other psychiatric medications. The authors controlled for confounding by using multivariate models and propensity-scoring methods. Secondary analyses included a no-medication group and examination of mortality causes.
All groups taking antipsychotics had significantly higher mortality rates (22.6%-29.1%) than patients taking nonantipsychotic medications (14.6%). Adjusted mortality risks for atypicals and for combined atypical and conventional antipsychotics were similar to those for conventional antipsychotics. The mortality risk was significantly lower for nonantipsychotic medications than conventional antipsychotics. Except for anticonvulsants, the adjusted risks for all individual classes of nonantipsychotics were significantly lower than the risk for antipsychotics. Mortality risks did not change over 12 months. The proportions of patients taking antipsychotics who died from cerebrovascular, cardiovascular, or infectious causes were not higher than rates for those taking nonantipsychotic psychiatric medications.
Antipsychotic medications taken by patients with dementia were associated with higher mortality rates than were most other medications used for neuropsychiatric symptoms. The association between mortality and antipsychotics is not well understood and may be due to a direct medication effect or the pathophysiology underlying neuropsychiatric symptoms that prompt antipsychotic use.
比较开始使用新型抗精神病药物治疗痴呆神经精神症状后一年内的死亡率与开始使用其他精神科药物后的死亡率。
这项回顾性队列研究使用了退伍军人事务部（2001 - 2005财年）的全国数据，研究对象为65岁以上在痴呆诊断后开始接受精神科药物门诊治疗的患者（N = 10,615）。比较服用抗精神病药物的患者和服用其他精神科药物的患者的12个月死亡率。作者使用多变量模型和倾向评分方法来控制混杂因素。二次分析包括一个未用药组和对死亡原因的检查。
所有服用抗精神病药物的组的死亡率（22.6% - 29.1%）均显著高于服用非抗精神病药物的患者（14.6%）。非典型抗精神病药物以及非典型与传统抗精神病药物联合使用的调整后死亡风险与传统抗精神病药物相似。非抗精神病药物的死亡风险显著低于传统抗精神病药物。除抗惊厥药物外，所有各类非抗精神病药物的调整后风险均显著低于抗精神病药物的风险。12个月内死亡风险没有变化。服用抗精神病药物的患者死于脑血管、心血管或感染性原因的比例并不高于服用非抗精神病精神科药物的患者。
痴呆患者服用抗精神病药物的死亡率高于用于治疗神经精神症状的大多数其他药物。死亡率与抗精神病药物之间的关联尚不清楚，可能是由于药物的直接作用或促使使用抗精神病药物的神经精神症状的病理生理学原因。
