Yang Hang-Ju, Cheng Wan-Ju
Department of Emergency Medicine, Jen-Ai Hospital, 483 Dong Rong Road, Taichung, 41265, Taiwan.
Department of Psychiatry, China Medical University Hospital, 2 Yude Road, Taichung, 40447, Taiwan.
Psychopharmacology (Berl). 2017 Mar;234(5):869-876. doi: 10.1007/s00213-017-4525-9. Epub 2017 Jan 11.
Hyponatremia affects 10% of patients with chronic schizophrenia and can lead to severe consequences. However, the role of antipsychotics and other risk factors in hyponatremia occurrence has remained inconsistent.
This study examined the association between antipsychotic use and hyponatremia occurrence in patients with schizophrenia.
We utilized the National Health Insurance Research Database to follow 2051 patients with schizophrenia from 1998 to 2013. Among them, 137 (6.7%) developed hyponatremia. Sociodemographic characteristics, physical comorbidities, and psychiatric treatment experiences were compared between those who had hyponatremia and those who did not. A Cox proportional hazards model was used to examine the hazard ratios (HRs) of these characteristics.
In patients with hyponatremia, the mean age at first hyponatremia occurrence was 54.7 ± 13.9 years, an average of 9.5 ± 4.0 years after schizophrenia diagnosis, and 32.9% of them were off antipsychotics before hyponatremia occurrences. Age at schizophrenia diagnosis (HR = 1.1), low-income household (HR = 2.4), comorbidities (HR = 1.2), and psychiatric admissions (HR = 1.04) were associated with the risks of hyponatremia. Compared with no antipsychotic use, atypical (HR = 2.1) and typical antipsychotics (HR = 3.1) were associated with an elevated risk of hyponatremia, after adjustment for age, sex, and physical comorbidities. Carbamazepine use (HR = 2.9) was also a significant risk factor for hyponatremia (p < 0.05).
Antipsychotic use in patients with schizophrenia with polypharmacy should be monitored for hyponatremia occurrences. Clinicians should pay attention to the impact of poor living conditions on hyponatremia occurrence.
低钠血症影响10%的慢性精神分裂症患者，并可能导致严重后果。然而，抗精神病药物及其他风险因素在低钠血症发生中的作用仍不一致。
本研究调查精神分裂症患者使用抗精神病药物与低钠血症发生之间的关联。
我们利用国民健康保险研究数据库，对1998年至2013年间的2051例精神分裂症患者进行随访。其中，137例（6.7%）发生了低钠血症。比较了发生低钠血症患者与未发生低钠血症患者的社会人口学特征、躯体合并症和精神科治疗经历。采用Cox比例风险模型检验这些特征的风险比（HRs）。
在发生低钠血症的患者中，首次发生低钠血症的平均年龄为54.7±13.9岁，精神分裂症诊断后平均9.5±4.0年，其中32.9%的患者在发生低钠血症前停用了抗精神病药物。精神分裂症诊断时的年龄（HR = 1.1）、低收入家庭（HR = 2.4）、合并症（HR = 1.2）和精神科住院（HR = 1.04）与低钠血症风险相关。在调整年龄、性别和躯体合并症后，与未使用抗精神病药物相比，非典型（HR = 2.1）和典型抗精神病药物（HR = 3.1）与低钠血症风险升高相关。使用卡马西平（HR = 2.9）也是低钠血症的一个显著风险因素（p < 0.05）。
对于联用多种药物的精神分裂症患者，应监测使用抗精神病药物时低钠血症的发生情况。临床医生应注意生活条件差对低钠血症发生的影响。
