Strømme Maria Fagerbakke, Thue Augustsson Mina, Bartz-Johannessen Christoffer, Stautland Andrea, Mykletun Arnstein, Kroken Rune Andreas, Mehlum Lars, Kjelby Eirik, Johnsen Erik
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
Mohn Research Center for Psychotic Disorders, Bergen, Norway.
Psychol Med. 2024 Dec 9;54(16):1-9. doi: 10.1017/S0033291724002873.
The lifetime prevalence of suicide is around 5% in patients with schizophrenia. Non-adherence to antipsychotic medication is an important risk factor, but prospective studies investigating joint effects of antipsychotic drugs, antidepressants, and benzodiazepines on suicidality are scarce. We aimed to investigate how use and non-use of psychotropic medications are associated with suicidality in schizophrenia.
An open cohort study followed all patients consecutively admitted to a psychiatric acute unit during a 10-year period with a diagnosis of schizophrenia ( = 696). Cox multiple regression analyses were conducted with use of antipsychotics, antidepressants, and benzodiazepines as time-dependent variables. Adjustments were made for age, gender, depressive mood, agitated behavior, and use of alcohol and illicit substances.
A total of 32 (4.6%) suicide events were registered during follow-up. Of these, 9 (28%) were completed suicides and 23 (72%) were attempted suicides. A total of 59 (8.5%) patients were readmitted with suicidal plans during the follow-up. Compared to non-use, use of antipsychotics was associated with 70% lower risk of attempted or completed suicide (adjusted hazard ratio [AHR] = 0.30, < 0.01, CI 0.14-0.65) and 69% reduced risk of readmission with suicidal plans (AHR = 0.31, < 0.01, CI 0.18-0.55). Use of prescribed benzodiazepines was associated with 126% increased risk of readmission with suicidal plans (AHR = 2.26, = 0.01, CI 1.24-4.13).
Adherence to antipsychotic medication is strongly associated with reduced suicidal risk in schizophrenia. The use of prescribed benzodiazepines was identified as a significant risk factor for being readmitted with suicidal plans.
精神分裂症患者的终身自杀患病率约为5%。不坚持服用抗精神病药物是一个重要的风险因素，但研究抗精神病药物、抗抑郁药物和苯二氮卓类药物对自杀倾向联合影响的前瞻性研究很少。我们旨在研究精神药物的使用和不使用如何与精神分裂症患者的自杀倾向相关。
一项开放性队列研究对在10年期间连续入住精神科急性病房且诊断为精神分裂症（n = 696）的所有患者进行随访。以抗精神病药物、抗抑郁药物和苯二氮卓类药物的使用作为时间依赖性变量进行Cox多元回归分析。对年龄、性别、抑郁情绪、激越行为以及酒精和非法物质的使用进行了调整。
随访期间共记录了32起（4.6%）自杀事件。其中，9起（28%）为自杀死亡，23起（72%）为自杀未遂。随访期间共有59名（8.5%）患者带着自杀计划再次入院。与未使用相比，使用抗精神病药物与自杀未遂或自杀死亡风险降低70%相关（调整后风险比[AHR]=0.30，P<0.01，95%置信区间0.14 - 0.65），且带着自杀计划再次入院的风险降低69%（AHR = 0.31，P<0.01，95%置信区间0.18 - 0.55）。使用处方苯二氮卓类药物与带着自杀计划再次入院的风险增加126%相关（AHR = 2.26，P = 0.01，95%置信区间1.24 - 4.13）。
坚持服用抗精神病药物与精神分裂症患者自杀风险降低密切相关。使用处方苯二氮卓类药物被确定为带着自杀计划再次入院的一个重要风险因素。
