Felker B, Yazel J J, Short D
University of Washington School of Medicine, Seattle, USA.
Psychiatr Serv. 1996 Dec;47(12):1356-63. doi: 10.1176/ps.47.12.1356.
To fuel advocacy for improved health care for mentally ill persons, the authors reviewed the literature that describes excess mortality and underrecognition and undertreatment of comorbid medical conditions in this population. Barriers to optimal primary medical care for psychiatric patients are discussed.
A MEDLINE search focusing on mortality and medical problems in psychiatric patients yielded 66 papers in English published between 1934 and 1996. These studies and a German paper from 1912 are included in the review.
Standardized mortality ratios for psychiatric patients, derived from comparisons with the general population and matched control groups, have repeatedly demonstrated excess mortality from both natural and unnatural causes among psychiatric patients. Several large studies that have attempted to clarify the issues underlying increased death rates are discussed. Although no single diagnostic group emerges as being at particularly high risk, substance abuse disorders alone or in combination with other psychiatric disorders have been repeatedly found to lead to increased mortality rates. Other studies have also repeatedly demonstrated that psychiatric patients suffer a high rate of comorbid medical illnesses, which are largely undiagnosed and untreated and which may cause or exacerbate psychiatric symptoms. Atypical presentations are common, and changes in vision are the symptoms most predictive of medical illness. Elderly patients and those with diagnoses of organic brain syndromes are at highest risk for comorbid medical illness. Parity in the medical and mental health treatment of psychiatric patients requires both political advocacy and development of primary care programs capable of efficiently meeting their needs.
为推动改善对精神病患者的医疗保健，作者回顾了描述该人群中过高死亡率以及共病医疗状况未被充分认识和治疗的文献。讨论了为精神病患者提供最佳初级医疗保健的障碍。
对MEDLINE进行检索，重点关注精神病患者的死亡率和医疗问题，共检索到1934年至1996年间以英文发表的66篇论文。本综述纳入了这些研究以及一篇1912年的德语论文。
通过与普通人群和匹配对照组进行比较得出的精神病患者标准化死亡率，反复表明精神病患者因自然和非自然原因导致的死亡率过高。讨论了几项试图阐明死亡率上升背后问题的大型研究。尽管没有一个单一的诊断组显示出特别高的风险，但单独的物质使用障碍或与其他精神障碍合并存在时，反复被发现会导致死亡率上升。其他研究也反复表明，精神病患者共病医疗疾病的发生率很高，这些疾病大多未被诊断和治疗，可能会导致或加重精神症状。非典型表现很常见，视力变化是最能预测医疗疾病的症状。老年患者和被诊断为器质性脑综合征的患者共病医疗疾病的风险最高层。在精神病患者的医疗和心理健康治疗方面实现平等，既需要政治倡导，也需要制定能够有效满足他们需求的初级保健项目。
