Langballe Ellen Melbye, Engdahl Bo, Nordeng Hedvig, Ballard Clive, Aarsland Dag, Selbæk Geir
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
Am J Geriatr Psychiatry. 2014 Apr;22(4):321-31. doi: 10.1016/j.jagp.2013.06.007. Epub 2013 Sep 7.
To investigate short- and long-term mortality risk associated with the use of antipsychotics in dementia outpatients, assessing the risk over specific time frames and quantifying the risk by the individual antipsychotics.
This population-based study used data from the Norwegian Prescription Database. The study sample included 26,940 dementia outpatients aged 65 years or older prescribed antidementia drugs and psychotropics from Norwegian pharmacies between 2004 and 2010.
Cox survival analyses, adjusted for age, gender, mean daily defined dose, and severe medical conditions, showed that antipsychotic use compared with other psychotropics involved approximately twice the mortality risk in outpatients with dementia. Furthermore, these results are consistent for all investigated time points after first dispensing the drugs (hazard ratio [HR]30 days = 2.1 [95% confidence interval {CI}: 1.6-2.9] to HR 730-2,400 days = 1.7 [95% CI: 1.6-1.9]). Haloperidol was associated with higher mortality risk (HR 30 days = 1.7 [95% CI: 1.0-3.0] to HR 730-2,400 days = 1.4 [95% CI: 1.0-1.9]) than risperidone.
This first study to observe antipsychotic use and mortality in dementia outpatients over more than 6 years clearly shows that antipsychotics involve increased short- and long-term mortality risk. Physicians may justly consider antipsychotics to be the best option for some dementia patients among available nonpharmacologic and pharmacologic treatments. However, although causal conclusions are precluded due to limited adjustments in the analyses, the findings support the current treatment recommendations that antipsychotics should be avoided or used with great caution.
调查痴呆门诊患者使用抗精神病药物相关的短期和长期死亡风险，评估特定时间段内的风险，并按个体抗精神病药物量化风险。
这项基于人群的研究使用了挪威处方数据库的数据。研究样本包括2004年至2010年间从挪威药房开具抗痴呆药物和精神药物的26940名65岁及以上的痴呆门诊患者。
经年龄、性别、平均每日限定剂量和严重疾病校正后的Cox生存分析表明，与其他精神药物相比，痴呆门诊患者使用抗精神病药物的死亡风险约高出两倍。此外，在首次配药后的所有调查时间点，这些结果都是一致的（风险比[HR]30天 = 2.1[95%置信区间{CI}：1.6 - 2.9]至HR 730 - 2400天 = 1.7[95%CI：1.6 - 1.9]）。与利培酮相比，氟哌啶醇的死亡风险更高（HR 30天 = 1.7[95%CI：1.0 - 3.0]至HR 730 - 2400天 = 1.4[95%CI：1.0 - 1.9]）。
这项首次观察痴呆门诊患者使用抗精神病药物及死亡率超过6年的研究清楚地表明，抗精神病药物会增加短期和长期死亡风险。在可用的非药物和药物治疗中，医生可能有理由认为抗精神病药物是某些痴呆患者的最佳选择。然而，尽管由于分析中的调整有限而无法得出因果结论，但研究结果支持目前的治疗建议，即应避免或极其谨慎地使用抗精神病药物。
