Dutta Rina, Murray Robin M, Hotopf Matthew, Allardyce Judith, Jones Peter B, Boydell Jane
Department of Psychosis Studies, Institute of Psychiatry, King's College London, England.
Arch Gen Psychiatry. 2010 Dec;67(12):1230-7. doi: 10.1001/archgenpsychiatry.2010.157.
The long-term risk of suicide after a first episode of psychosis is unknown because previous studies often have been based on prevalence cohorts, been biased to more severely ill hospitalized patients, extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses.
To determine the epidemiology of suicide in a clinically representative cohort of patients experiencing their first episode of psychosis.
Retrospective inception cohort.
Geographic catchment areas in London, England (between January 1, 1965, and December 31, 2004; n = 2056); Nottingham, England (between September 1, 1997, and August 31, 1999; n = 203); and Dumfries and Galloway, Scotland (between January 1, 1979, and December 31, 1998; n = 464).
All 2723 patients who presented for the first time to secondary care services with psychosis in the 3 defined catchment areas were traced after a mean follow-up period of 11.5 years.
Deaths by suicide and open verdicts according to the International Classification of Diseases (seventh through tenth editions).
The case fatality from suicide was considerably lower than expected from previous studies (1.9% [53/2723]); the proportionate mortality was 11.9% (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with a median time to suicide of 5.6 years. Suicide occurred approximately 12 times more than expected from the general population of England and Wales (standardized mortality ratio, 11.65; 95% confidence interval, 8.73-15.24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation-a time when there may be less intense clinical monitoring of risk-suicide risk remained almost 4 times higher than in the general population (standardized mortality ratio, 3.92; 95% confidence interval, 2.22-6.89).
The highest risk of suicide after a psychotic episode occurs soon after presentation, yet physicians should still be vigilant in assessing risk a decade or longer after first contact. The widely held view that 10% to 15% die of suicide is misleading because it refers to proportionate mortality, not lifetime risk. Nevertheless, there is a substantial increase in risk of suicide compared with the general population.
首次发作精神病后自杀的长期风险尚不清楚，因为以往的研究通常基于患病率队列，偏向病情更严重的住院患者，从短期随访时间进行推断，并且对精神分裂症和其他精神病进行了区分。
确定首次发作精神病的具有临床代表性的患者队列中自杀的流行病学情况。
回顾性起始队列研究。
英国伦敦的地理集水区（1965年1月1日至2004年12月31日；n = 2056）；英国诺丁汉（1997年9月1日至1999年8月31日；n = 203）；以及苏格兰邓弗里斯和加洛韦（1979年1月1日至1998年12月31日；n = 464）。
在3个确定的集水区首次到二级护理服务机构就诊的所有2723例精神病患者，经过平均11.5年的随访进行追踪。
根据国际疾病分类（第七版至第十版）判定的自杀死亡和死因不明的死亡。
自杀病死率远低于以往研究的预期（1.9%[53/2723]）；比例死亡率为11.9%（53/444）。尽管自杀率在就诊后的第一年最高，但风险在随访后期仍然存在，自杀的中位时间为5.6年。自杀发生率比英格兰和威尔士普通人群预期的高出约12倍（标准化死亡比，11.65；95%置信区间，8.73 - 15.24），53例自杀中有49例为超额死亡。即使在首次就诊十年后——此时对风险的临床监测可能不那么密集——自杀风险仍几乎比普通人群高4倍（标准化死亡比，3.92；95%置信区间，2.22 - 6.89）。
精神病发作后自杀风险最高在就诊后不久出现，但医生在首次接触十年或更长时间后评估风险时仍应保持警惕。普遍认为10%至15%死于自杀的观点具有误导性，因为它指的是比例死亡率，而非终生风险。然而，与普通人群相比，自杀风险有大幅增加。
