Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications
Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications
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DOI：
10.1176/appi.ajp.2007.06101710
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发表时间：
2007-10-01
影响因子：
17.7
通讯作者：
Blow, Frederic C.
中科院分区：
文献类型：
--
作者：
Kales, Helen C.;Valenstein, Marcia;Blow, Frederic C.
目的：将开始使用新的抗精神病药物治疗痴呆的神经精神症状后一年的死亡率与开始使用其他精神药物后的死亡率进行比较。回顾展，一项队列研究使用了来自退伍军人事务部的国家数据（2001-2005财政年度）对65岁以上的患者在诊断为痴呆后开始接受精神科药物门诊治疗（10 615人）。比较了服用抗精神病药物和服用其他精神病药物的患者的两个月死亡率。作者通过使用多变量模型和倾向评分方法控制混杂因素。次要分析包括无药物治疗组和死亡原因检查。结果：所有服用抗精神病药物的组的死亡率（22.6%-29.1%）显著高于服用非抗精神病药物的患者（14.6%）。非典型抗精神病药和常规抗精神病药的校正死亡风险与常规抗精神病药相似。非抗精神病药物的死亡风险显着低于传统抗精神病药物。除抗惊厥药外，所有非抗精神病药的校正风险均显著低于抗精神病药。死亡风险在12个月内没有变化。服用抗精神病药物的患者死于脑血管，心血管或感染原因的比例并不高于那些服用非抗精神病药物的患者的死亡率。结论：痴呆患者服用抗精神病药物的死亡率高于大多数其他用于神经精神症状的药物。死亡率与抗精神病药物之间的关系尚不清楚，可能是由于直接的药物作用或促使抗精神病药物使用的潜在神经精神症状的病理生理学。
Objective: Mortality rates in the year following new antipsychotic medication starts for neuropsychiatric symptoms of dementia were compared with rates after starts of other psychiatric medications.Method: The retrospective, cohort study used national data from the Department of Veterans Affairs (fiscal years 2001-2005) on patients older than 65 years who began outpatient treatment with psychiatric medication following a dementia diagnosis (N = 10,615). Twelve-month mortality rates were compared in patients taking antipsychotics and those taking other psychiatric medications. The authors controlled for confounding by using multivariate models and propensity-scoring methods. Secondary analyses included a no-medication group and examination of mortality causes.Results: All groups taking antipsychotics had significantly higher mortality rates (22.6%-29.1%) than patients taking nonantipsychotic medications (14.6%). Adjusted mortality risks for atypicals and for combined atypical and conventional antipsychotics were similar to those for conventional antipsychotics. The mortality risk was significantly lower for nonantipsychotic medications than conventional antipsychotics. Except for anticonvulsants, the adjusted risks for all individual classes of nonantipsychotics were significantly lower than the risk for antipsychotics. Mortality risks did not change over 12 months. The proportions of patients taking antipsychotics who died from cerebrovascular, cardiovascular, or infectious causes were not higher than rates for those taking nonantipsychotic psychiatric medications.Conclusions: Antipsychotic medications taken by patients with dementia were associated with higher mortality rates than were most other medications used for neuro psychiatric symptoms. The association between mortality and antipsychotics is not well understood and may be due to a direct medication effect or the pathophysiology underlying neuropsychiatric symptoms that prompt antipsychotic use.