Faculty of Medicine, University Malaya, Department of Psychological Medicine, Lembah Pantai, Kuala Lumpur 50603, Malaysia.
Br J Gen Pract. 2013 Jan;63(606):e63-8. doi: 10.3399/bjgp13X660797.
It is unclear whether psychiatric disorders are specifically related to the terminal phase of cancer, or independent of the underlying disease.
To investigate the rate of psychiatric comorbidity and psychotropic drugs prescription in terminally ill patients in the GP setting, comparing both patients with terminal cancer and heart failure.
Retrospective cohort study using the Utrecht General Practitioner Research Network.
Equally-sized groups of patients with terminal cancer and heart failure were randomly selected from the database of four general practices over the years 2005-2009. Psychiatric comorbidities were determined using the International Classification for Primary Care (ICPC) codes and psychotropic drugs prescriptions using the Anatomical Therapeutic Chemical (ATC) Classification System codes.
A total of 191 terminally ill patients were included in the study (111 with cancer and 80 with heart failure). The mean age for patients with terminal cancer (70.8 years, standard deviation [SD] = 12.8) was 15 years younger than that of patients with heart failure (85.6 years, SD = 9.2). Half of the terminally ill patients (50.3 %) were prescribed psychotropics, but only 13.6% of them had obtained a psychiatric diagnosis. There were no significant differences in prevalence of psychiatric disease and psychotropic drug prescription between patients with terminal cancer and heart failure.
The results demonstrate a high use of psychotropic drugs in terminally ill patients, often in the absence of a formal diagnosis of a psychiatric disorder. The absence of differences between patients with cancer and heart failure suggests that psychiatric diagnoses and increased psychotropic prescriptions are primarily related to the terminal stage of the disease and not to the background of cancer or heart failure.
目前尚不清楚精神障碍是否与癌症终末期有特定关系，还是与潜在疾病无关。
调查在全科医生（GP）环境中终末期患者的精神共病率和精神药物处方情况，比较同时患有癌症和心力衰竭的患者。
使用乌得勒支全科医生研究网络进行回顾性队列研究。
从 2005 年至 2009 年间的四家全科诊所数据库中随机选择同等数量的患有终末期癌症和心力衰竭的患者。使用初级保健国际分类（ICPC）代码确定精神共病，使用解剖治疗化学（ATC）分类系统代码确定精神药物处方。
共有 191 名终末期患者纳入研究（111 名患有癌症，80 名患有心力衰竭）。患有癌症的终末期患者的平均年龄（70.8 岁，标准差[SD] = 12.8）比患有心力衰竭的患者年轻 15 岁（85.6 岁，SD = 9.2）。一半的终末期患者（50.3%）开了精神药物，但只有 13.6%的患者获得了精神科诊断。患有癌症和心力衰竭的终末期患者的精神疾病患病率和精神药物处方率无显著差异。
结果表明，终末期患者经常使用精神药物，但往往没有正式的精神障碍诊断。癌症和心力衰竭患者之间没有差异表明，精神科诊断和增加的精神药物处方主要与疾病的终末期有关，而与癌症或心力衰竭的背景无关。
