双相情感障碍与药物或非法物质中毒

Bipolar Disorder and Poisoning due to Medicines or Illegal Substances.

作者信息

Niskanen Mikko, Kärkkäinen Olli, Taipale Heidi, Lieslehto Johannes, Tiihonen Jari, Hamina Aleksi

机构信息

School of Pharmacy, University of Eastern Finland, Kuopio, Finland.

Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.

出版信息

Acta Psychiatr Scand. 2025 Oct;152(4):299-307. doi: 10.1111/acps.70017. Epub 2025 Jul 17.

DOI:10.1111/acps.70017

PMID:40675619

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12404883/

Abstract

BACKGROUND

Individuals with bipolar disorder face an elevated risk of premature death, often due to external causes such as accidental injuries, self-harm, and substance-related deaths. This study aimed to investigate the incidence of severe poisonings among individuals with bipolar disorder and to examine associated demographic and clinical factors.

METHODS

We conducted a cohort study using data from national registers in Finland, measuring hospitalizations and deaths due to poisoning by medicines or illegal substances in 1996-2018. Cox proportional hazards regression models were used to assess associations between predictor variables and poisoning outcomes.

RESULTS

The study population comprised 60,045 individuals aged 15-65 diagnosed with bipolar disorder in 1987-2018. During the study period, 13.1% (N = 7872) of the population experienced at least one poisoning resulting in hospitalization or death. The age-standardized rate of hospitalizations was 50.6 (95% CI, 49.5-51.7) per 1000 person-years and of deaths 1.8 (95% CI, 1.6-2.0) per 1000 person-years. The majority of poisonings leading to hospitalization (59.1%) or death (56.6%) were intentional and caused by pharmaceuticals (hospitalizations, 76.9%; deaths, 63.6%). Additionally, psychoactive narcotics and stimulants were the cause of 26.8% of the poisoning deaths. The strongest risk factors for hospitalization were substance use disorder (adjusted hazard ratio, aHR, 2.75, 95% CI, 2.61-2.90) and a history of suicide attempt (2.70, 2.52-2.88). The risk of poisoning death was most strongly associated with substance use disorder (3.02, 2.60-3.52) and a history of suicide attempt (2.38, 1.94-2.91). Female sex was associated with a higher risk of hospitalization (1.19, 1.14-1.25), but a lower risk of death (0.72, 0.62-0.82).

CONCLUSION

Individuals with bipolar disorder face a substantial risk of poisoning by medicines or illegal substances, with notable sex differences in hospitalization and death rates. Key risk factors include substance use disorder and a history of suicide attempt.

摘要

背景

双相情感障碍患者面临过早死亡的风险升高，这通常是由意外伤害、自我伤害和与物质相关的死亡等外部原因导致的。本研究旨在调查双相情感障碍患者中严重中毒的发生率，并研究相关的人口统计学和临床因素。

方法

我们利用芬兰国家登记处的数据进行了一项队列研究，统计了1996年至2018年因药物或非法物质中毒导致的住院和死亡情况。使用Cox比例风险回归模型评估预测变量与中毒结果之间的关联。

结果

研究人群包括1987年至2018年期间诊断为双相情感障碍的60,045名15至65岁的个体。在研究期间，13.1%（N = 7872）的人群经历了至少一次导致住院或死亡的中毒事件。年龄标准化的住院率为每1000人年50.6（95%置信区间，49.5 - 51.7），死亡率为每1000人年1.8（95%置信区间，1.6 - 2.0）。导致住院（59.1%）或死亡（56.6%）的大多数中毒事件是故意的，且由药物引起（住院：76.9%；死亡：63.6%）。此外，精神活性麻醉品和兴奋剂是26.8%的中毒死亡的原因。住院的最强风险因素是物质使用障碍（调整后的风险比，aHR，2.75，95%置信区间，2.61 - 2.90）和自杀未遂史（2.70, 2.52 - 2.88）。中毒死亡风险与物质使用障碍（3.02, 2.60 - 3.52）和自杀未遂史（2.38, 1.94 - 2.91）关联最为密切。女性性别与较高的住院风险相关（1.19, 1.14 - 1.25），但死亡风险较低（0.72, 0.62 - 0.82）。