抗精神病药相关致死性中毒，英格兰和威尔士，1993-2019：第二代抗精神病药的影响。

Department of Psychological Medicine, University of Otago, Wellington, New Zealand.

Department of Precision Medicine, Networked Services, King's College Hospital, London, United Kingdom.

J Clin Psychopharmacol. 2021;41(6):650-657. doi: 10.1097/JCP.0000000000001479.

BACKGROUND

Deaths from antipsychotic (AP) poisoning have increased in England and Wales despite restriction of the use of thioridazine in 2000.

METHODS

We analyzed data from the Office for National Statistics drug-related death database, England and Wales, 1993-2019, to investigate fatal AP poisoning.

RESULTS

There were 2286 deaths (62% male patients). Annual numbers of intentional AP-related fatal poisonings (suicides) were relatively stable (1993, 35; 2019, 44; median, 44; range, 30-60). Intentional overdose deaths involving clozapine (96 male, 25 female) increased from 1 in 1994 to 5 in 2003 and have since remained relatively constant (median, 6; range, 3-10 per annum). Unintentional second-generation AP-related fatal poisonings have increased steadily since 1998, featuring in 828 (74%) of all unintentional, AP-related fatal poisonings in the period studied (2019, 89%). There were 181 unintentional clozapine-related deaths, (107 [59%] alone without other drugs ± alcohol) as compared with 291 quetiapine-related deaths (86 [30%] alone without other drugs ± alcohol) and 314 unintentional olanzapine-related deaths (77 [25%] alone without other drugs ± alcohol). Some 75% of all unintentional clozapine- and olanzapine-related deaths were of male patients (78% and 73%, respectively) as compared with 58% of unintentional quetiapine-related fatal poisonings. Clozapine now features prominently in intentional and in unintentional AP-related fatal poisoning in England and Wales. Deaths of male patients predominate in both categories. There were also 77 and 86 deaths attributed to unintentional poisoning with olanzapine and with quetiapine, respectively, in the absence of other drugs.

CONCLUSIONS

More effort is needed to prevent unintentional deaths not only from clozapine but also from olanzapine and quetiapine.

背景

尽管 2000 年限制了硫利达嗪的使用，但英国和威尔士的抗精神病药（AP）中毒死亡人数仍有所增加。

方法

我们分析了英格兰和威尔士国家统计局药物相关死亡数据库 1993-2019 年的数据，以调查致命性 AP 中毒情况。

结果

共有 2286 例死亡（62%为男性患者）。故意与 AP 相关的致命中毒（自杀）的年死亡人数相对稳定（1993 年 35 例；2019 年 44 例；中位数 44 例；范围 30-60 例）。涉及氯氮平的故意过量死亡（96 例男性，25 例女性）从 1994 年的 1 例增加到 2003 年的 5 例，此后一直相对稳定（中位数 6 例；范围每年 3-10 例）。自 1998 年以来，非故意第二代 AP 相关致命中毒事件稳步增加，在所研究期间（2019 年，89%）所有非故意、与 AP 相关的致命中毒事件中占 828 例（74%）。有 181 例非故意氯氮平相关死亡（单独使用氯氮平而无其他药物和/或酒精的患者 107 例[59%]），291 例喹硫平相关死亡（单独使用喹硫平而无其他药物和/或酒精的患者 86 例[30%]），314 例非故意奥氮平相关死亡（单独使用奥氮平而无其他药物和/或酒精的患者 77 例[25%]）。所有非故意氯氮平和奥氮平相关死亡中，约 75%的患者为男性（分别为 78%和 73%），而非故意喹硫平相关致命中毒患者中，58%为男性。氯氮平现在在英格兰和威尔士的故意和非故意 AP 相关致命中毒中都占有重要地位。两类中毒患者均以男性为主。在没有其他药物的情况下，也分别有 77 例和 86 例与奥氮平和喹硫平非故意中毒相关的死亡。