Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark4Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
JAMA. 2014 Mar 19;311(11):1133-42. doi: 10.1001/jama.2014.2137.
The relationship between critical illness and psychiatric illness is unclear.
To assess psychiatric diagnoses and medication prescriptions before and after critical illness.
DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patients in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population.
Critical illness defined as intensive care unit admission with mechanical ventilation.
Adjusted prevalence ratios (PRs) of psychiatrist-diagnosed psychiatric illnesses and prescriptions for psychoactive medications in the 5 years before critical illness. For patients with no psychiatric history, quarterly cumulative incidence (risk) and adjusted hazard ratios (HRs) for diagnoses and medications in the following year, using Cox regression.
Among 24,179 critically ill patients, 6.2% had 1 or more psychiatric diagnoses in the prior 5 years vs 5.4% for hospitalized patients (adjusted PR, 1.31; 95% CI, 1.22-1.42; P<.001) and 2.4% for the general population (adjusted PR, 2.57; 95% CI, 2.41-2.73; P<.001). Five-year preadmission psychoactive prescription rates were similar to hospitalized patients: 48.7% vs 48.8% (adjusted PR, 0.97; 95% CI, 0.95-0.99; P<.001) but were higher than the general population (33.2%; adjusted PR, 1.40; 95% CI, 1.38-1.42; P<.001). Among the 9912 critical illness survivors with no psychiatric history, the absolute risk of new psychiatric diagnoses was low but higher than hospitalized patients: 0.5% vs 0.2% over the first 3 months (adjusted HR, 3.42; 95% CI, 1.96-5.99; P <.001), and the general population cohort (0.02%; adjusted HR, 21.77; 95% CI, 9.23-51.36; P<.001). Risk of new psychoactive medication prescriptions was also increased in the first 3 months: 12.7% vs 5.0% for the hospital cohort (adjusted HR, 2.45; 95% CI, 2.19-2.74; P<.001) and 0.7% for the general population (adjusted HR, 21.09; 95% CI, 17.92-24.82; P<.001). These differences had largely resolved by 9 to 12 months after discharge.
Prior psychiatric diagnoses are more common in critically ill patients than in hospital and general population cohorts. Among survivors of critical illness, new psychiatric diagnoses and psychoactive medication use is increased in the months after discharge. Our data suggest both a possible role of psychiatric disease in predisposing patients to critical illness and an increased but transient risk of new psychiatric diagnoses and treatment after critical illness.
危重病与精神疾病之间的关系尚不清楚。
评估危重病前后的精神科诊断和药物处方。
设计、地点和参与者：丹麦的一项基于人群的队列研究，纳入了 2006 年至 2008 年期间入住重症监护病房并接受机械通气的危重病患者，以及同期来自住院患者和一般人群的 2 个匹配对照队列。
危重病定义为入住重症监护病房并接受机械通气。
在危重病发生前 5 年内，精神科诊断为精神疾病和精神药物处方的调整后患病率比（PRs）。对于无精神病史的患者，使用 Cox 回归分析在接下来的 1 年内诊断和药物治疗的季度累积发生率（风险）和调整后的危险比（HRs）。
在 24179 名危重病患者中，6.2%的患者在之前 5 年内有 1 种或多种精神科诊断，而住院患者为 5.4%（调整后 PR，1.31；95%CI，1.22-1.42；P<.001），一般人群为 2.4%（调整后 PR，2.57；95%CI，2.41-2.73；P<.001）。入院前 5 年的精神药物处方率与住院患者相似：48.7%比 48.8%（调整后 PR，0.97；95%CI，0.95-0.99；P<.001），但高于一般人群（33.2%；调整后 PR，1.40；95%CI，1.38-1.42；P<.001）。在 9912 名无精神病史的危重病幸存者中，新发精神科诊断的绝对风险较低，但高于住院患者：前 3 个月为 0.5%比 0.2%（调整后 HR，3.42；95%CI，1.96-5.99；P <.001），高于一般人群队列（0.02%；调整后 HR，21.77；95%CI，9.23-51.36；P<.001）。前 3 个月新精神药物处方的风险也增加：12.7%比住院患者队列的 5.0%（调整后 HR，2.45；95%CI，2.19-2.74；P<.001）和一般人群的 0.7%（调整后 HR，21.09；95%CI，17.92-24.82；P<.001）。这些差异在出院后 9 至 12 个月基本得到解决。
与住院患者和一般人群队列相比，危重病患者的既往精神科诊断更为常见。在危重病幸存者中，出院后几个月新发精神科诊断和精神药物使用增加。我们的数据表明，精神疾病可能在使患者易患危重病方面发挥作用，并且在危重病后存在新的但短暂的精神科诊断和治疗风险。
