Centre of Primary Care and Public Health,Queen Mary University of London,London,UK.
Daroca Primary Care Centre,Madrid,Spain.
Psychol Med. 2018 Dec;48(16):2693-2701. doi: 10.1017/S0033291718000302. Epub 2018 Mar 1.
The high cardiovascular (CV) morbidity and mortality reported for patients with psychiatric disorders may possibly be due to a poorer management of CV risk factors (CVRFs). However, these healthcare disparities remain poorly understood. In this paper, studies comparing the management of smoking, diabetes, hypertension and dyslipidaemia, in patients with and without depression, anxiety, schizophrenia, bipolar or personality disorder, were reviewed.
Prospective studies comparing rates of screening, diagnosis, treatment and control of CVRFs were searched in PubMed, Embase, PsychInfo, Scopus and Web of Science (inception to January 2017). The Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria were used. Studies were assessed for quality. Wherever possible, meta-analyses were conducted to summarize the findings.
Twenty studies, out of the 18 333 references initially identified, were included. Most studies were heterogeneous in design. Two areas permitted meta-analyses: the pooled odds ratio for quitting smoking for those with depression was 0.64 (0.49-0.80) p < 0.001; the pooled difference of glycated haemoglobin for patients with type 2 diabetes and depression was 0.18 (0.06-0.31) p = 0.005. Individual studies showed associations between: schizophrenia and lower probability of having smoking habit recorded; schizoid personality disorder and higher probability of remaining non-smokers after quitting; anxiety and poorer control of type I diabetes; depression, anxiety or schizophrenia and lower probability of having a diagnosis of hypertension; schizophrenia or bipolar disorder and lower use of antihypertensive and lipid-lowering drugs.
A proactive clinical management, together with further studies, are needed to reduce the CV morbidity and mortality of patients with psychiatric disorders.
精神疾病患者心血管发病率和死亡率较高，这可能是由于心血管危险因素（CVRF）管理不善所致。然而，这些医疗保健方面的差异仍未得到充分理解。本文回顾了比较抑郁、焦虑、精神分裂症、双相情感障碍或人格障碍患者与无上述精神疾病患者吸烟、糖尿病、高血压和血脂异常管理情况的研究。
在 PubMed、Embase、PsychInfo、Scopus 和 Web of Science（从创建至 2017 年 1 月）中搜索比较 CVRF 筛查、诊断、治疗和控制率的前瞻性研究。采用观察性研究荟萃分析（MOOSE）标准进行研究评估。对研究进行质量评估。只要有可能，就进行荟萃分析以总结研究结果。
从最初确定的 18333 篇参考文献中，有 20 篇研究符合纳入标准。大多数研究在设计上存在异质性。有两个领域允许进行荟萃分析：有抑郁的患者戒烟的合并优势比为 0.64（0.49-0.80）p<0.001；2 型糖尿病合并抑郁患者的糖化血红蛋白差值为 0.18（0.06-0.31）p=0.005。个别研究表明：精神分裂症与吸烟可能性较低相关；分裂样人格障碍与戒烟后继续保持非吸烟状态的可能性较高相关；焦虑与 1 型糖尿病控制较差相关；抑郁、焦虑或精神分裂症与高血压诊断可能性较低相关；精神分裂症或双相情感障碍与降压药和降脂药使用可能性较低相关。
需要采取积极的临床管理措施，并进一步开展研究，以降低精神疾病患者的心血管发病率和死亡率。
