Loas G, Azi A, Noisette C, Yon V
Service universitaire de psychiatrie, hôpital Pinel, 80044 Amiens cedex 01, France.
Encephale. 2008 Jan;34(1):54-60. doi: 10.1016/j.encep.2007.07.005. Epub 2007 Sep 5.
The aim of this study was to quantify the mortality risk in chronic schizophrenic patients, ten to 14 years after the initial evaluation. Furthermore, using sociodemographical, clinical and psychometrical variables evaluated at inclusion, predictors of global or mortality by suicide were explored.
One hundred and fifty subjects meeting the research diagnostic criteria (RDC) for chronic schizophrenia were included in the study between 1991 and 1995. At the initial assessment, the following variables were assessed: sex, age, level of education, number of hospitalisations, mean duration of the illness, scores on the physical anhedonia scale, the brief psychiatric rating scale (BPRS), the positive and negative syndrome scale (PANSS), and Beck's depression inventory (BDI). In May 2005, all the subjects were assessed using direct or indirect methods. Survival analysis was conducted using the Kaplan-Meier product-limit estimator and a standardized mortality ratio (SMR) was calculated. Multivariate Cox regression was performed to detect predictive factors associated with mortality.
The absolute mortality rate was of 18.57% and the RSM of 4.83. The absolute mortality rate for suicide was 6.98%. Multivariate Cox regression analyses showed that two factors (high rate of males, high dose of antipsychotics) were related to an increase in global mortality risk. Moreover, high dose of antipsychotics and a high rate of "positive" subjects, as evaluated by the PANSS, were related to an increase in mortality risk by suicide.
High dose of neuroleptics could characterize the severe form of schizophrenia, the risk of mortality of which was higher than that of the less severe forms. Another explanation was that high doses of neuroleptics could lead to severe side effects and thus an increase in the vulnerability of schizophrenics to organic diseases. Positive, contrary to negative, symptoms could increase the risk of suicide. This 14-year follow-up study confirmed the increased mortality rates by natural and non natural causes observed in chronic schizophrenic subjects.
本研究旨在量化慢性精神分裂症患者在初次评估后10至14年的死亡风险。此外，利用纳入时评估的社会人口统计学、临床和心理测量学变量，探究全因死亡或自杀死亡的预测因素。
1991年至1995年间，150名符合慢性精神分裂症研究诊断标准（RDC）的受试者纳入本研究。初次评估时，评估以下变量：性别、年龄、教育程度、住院次数、疾病平均病程、躯体快感缺失量表得分、简明精神病评定量表（BPRS）、阳性和阴性症状量表（PANSS）以及贝克抑郁量表（BDI）。2005年5月，采用直接或间接方法对所有受试者进行评估。使用Kaplan-Meier乘积限估计法进行生存分析，并计算标准化死亡比（SMR）。进行多变量Cox回归以检测与死亡相关的预测因素。
绝对死亡率为18.57%，标准化死亡比为4.83。自杀绝对死亡率为6.98%。多变量Cox回归分析显示，两个因素（男性比例高、抗精神病药物高剂量）与全因死亡风险增加有关。此外，抗精神病药物高剂量以及PANSS评估的“阳性”受试者比例高与自杀死亡风险增加有关。
高剂量抗精神病药物可能是精神分裂症严重形式的特征，其死亡风险高于较轻形式。另一种解释是，高剂量抗精神病药物可能导致严重副作用，从而增加精神分裂症患者对器质性疾病的易感性。与阴性症状相反，阳性症状可能增加自杀风险。这项14年的随访研究证实了慢性精神分裂症患者中观察到的自然和非自然原因导致的死亡率增加。
