Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan.
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
Schizophr Bull. 2020 Jul 8;46(4):795-803. doi: 10.1093/schbul/sbz126.
Young people are disproportionately affected by sexually transmitted infections (STIs). The risk of STIs in young people following first-episode schizophrenia is unknown. This study using Taiwan's National Health Insurance Research Database enrolled 44 109 adolescents and young adults with first-episode schizophrenia and 176 436 age- and sex-matched controls without schizophrenia from 2001 through 2009 and followed to the end of 2011. New-onset STIs were identified. Survival analysis was performed. Cox regression analysis was used to examine the effects of comorbid substance use disorder (SUD), schizophrenia medications, and schizophrenia severity. The E value for causality of evidence was calculated. We found that young people had a higher risk of STIs following first-episode schizophrenia compared with controls without schizophrenia (hazard ratio [HR] = 2.35, 95% CI = 2.08-2.64); these STIs included human immunodeficiency virus (HIV) (3.70, 2.60-5.28) and syphilis (5.35, 3.96-7.23). They also showed a disproportionate distribution of STIs, with an increased proportion of syphilis (20.4% vs 8.2%) and HIV (9.1% vs 6.0%). When presenting with SUD, the risks of HIV (11.00, 7.02-17.25) and syphilis (9.11, 6.16-13.47) were further increased. The severe schizophrenia group had an extremely high risk of syphilis (41.26, 27.69-61.47) and HIV (7.50, 3.85-14.62). Schizophrenia medications may provide beneficial effects against contracting STIs (0.77, 0.68-0.89). We concluded that following first-episode schizophrenia, young patients are at higher risk of STIs, particularly HIV and syphilis. The risk further increased when subjects presented with SUD or severe schizophrenia. Importantly, antipsychotic treatment may lower the risk of STIs.
年轻人受到性传播感染（STI）的影响不成比例。年轻人首次出现精神分裂症后感染性传播感染的风险尚不清楚。本研究使用台湾全民健康保险研究数据库，招募了 44109 名首次出现精神分裂症的青少年和年轻人以及 176436 名年龄和性别匹配的无精神分裂症对照者，从 2001 年至 2009 年随访至 2011 年底。确定新发 STI。进行生存分析。使用 Cox 回归分析检查合并物质使用障碍（SUD）、精神分裂症药物和精神分裂症严重程度的影响。计算因果证据的 E 值。我们发现，与无精神分裂症的对照者相比，年轻人首次出现精神分裂症后感染 STI 的风险更高（风险比[HR]=2.35，95%CI=2.08-2.64）；这些 STI 包括人类免疫缺陷病毒（HIV）（3.70，2.60-5.28）和梅毒（5.35，3.96-7.23）。他们还表现出 STI 的不成比例分布，梅毒（20.4%比 8.2%）和 HIV（9.1%比 6.0%）的比例增加。当出现 SUD 时，HIV（11.00，7.02-17.25）和梅毒（9.11，6.16-13.47）的风险进一步增加。严重精神分裂症组梅毒（41.26，27.69-61.47）和 HIV（7.50，3.85-14.62）的风险极高。精神分裂症药物可能对预防感染性传播疾病有有益作用（0.77，0.68-0.89）。我们的结论是，首次出现精神分裂症后，年轻患者感染 STI 的风险较高，尤其是 HIV 和梅毒。当患者出现 SUD 或严重精神分裂症时，风险进一步增加。重要的是，抗精神病药物治疗可能会降低 STI 的风险。
