Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Psychiatry, Chang Gung Memorial Hospital, Lin-Kou & Chang Gung University, Lin-Kou, Taiwan.
J Affect Disord. 2018 Jan 15;226:77-84. doi: 10.1016/j.jad.2017.09.020. Epub 2017 Sep 21.
To investigate the association between psychotropic agents (including antipsychotics, antidepressants and mood stabilizers) and risk of stroke among patients with bipolar disorders.
We conducted a disease risk score-matched nested case-control study and identified patients with bipolar disorders (ICD-9 codes: 296.0x, 296.1x, 296.4x, 296.5x, 296.6x, 296.7x, 296.80, 296.81 or 296.89) from the National Health Insurance Research Database in Taiwan. Among them, we identified 1232 cases (981 were ischemic stroke and 251 were hemorrhagic stroke) and 5314 disease risk score-matched controls. Conditional logistic regression model equations were applied to determine the effect of psychotropic agents on stroke risk among patients with bipolar disorders.
The results indicated that overall use of psychotropic agents was associated with an increased risk of stroke (adjusted odds ratio [AOR] = 1.82; 95% confidence interval [CI]: 1.56-2.13). When classifying psychotropic agents into antipsychotics, antidepressants and mood stabilizers, respectively, a significant positive association was found for users of antipsychotics (AOR = 1.98; 95% CI = 1.53-2.56), antidepressants (AOR = 1.44; 95% CI = 1.16-1.79), and mood stabilizers (AOR = 1.89; 95% CI = 1.22-2.93). Combined use of psychotropic agents was associated with higher risk of stroke than monotherapy (AOR = 2.62; 95% CI = 1.98-3.45).
The results support our hypothesis that psychotropic use is associated with increased risk of stroke among patients with bipolar disorders. The stroke risks are higher among patients with polypharmacy than those with monotherapy. These findings warrant further investigation to confirm and replicate the findings using different methodologies and populations, and to mitigate residual confounding.
研究精神药物（包括抗精神病药、抗抑郁药和心境稳定剂）与双相情感障碍患者中风风险之间的关联。
我们进行了疾病风险评分匹配的巢式病例对照研究，从台湾全民健康保险研究数据库中确定了双相情感障碍患者（ICD-9 代码：296.0x、296.1x、296.4x、296.5x、296.6x、296.7x、296.80、296.81 或 296.89）。其中，我们确定了 1232 例病例（981 例为缺血性中风，251 例为出血性中风）和 5314 例疾病风险评分匹配的对照。应用条件逻辑回归模型方程确定双相情感障碍患者使用精神药物对中风风险的影响。
结果表明，总体使用精神药物与中风风险增加相关（调整后的优势比 [AOR] = 1.82；95%置信区间 [CI]：1.56-2.13）。当将精神药物分类为抗精神病药、抗抑郁药和心境稳定剂时，抗精神病药使用者（AOR = 1.98；95%CI = 1.53-2.56）、抗抑郁药使用者（AOR = 1.44；95%CI = 1.16-1.79）和心境稳定剂使用者（AOR = 1.89；95%CI = 1.22-2.93）均存在显著正相关。与单药治疗相比，联合使用精神药物与中风风险升高相关（AOR = 2.62；95%CI = 1.98-3.45）。
结果支持我们的假设，即精神药物的使用与双相情感障碍患者中风风险增加有关。与单药治疗相比，多药治疗的患者中风风险更高。这些发现需要进一步研究，以使用不同的方法和人群来证实和复制这些发现，并减轻残留混杂因素的影响。
