Acute general hospital admissions in people with serious mental illness.
Acute general hospital admissions in people with serious mental illness.
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DOI：
10.1017/s0033291718000284
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发表时间：
2018-12
影响因子：
6.9
通讯作者：
Stewart R
中科院分区：
文献类型：
--
作者：
Jayatilleke N;Hayes RD;Chang CK;Stewart R
严重精神疾病（SMI，包括精神分裂症、情感障碍和双相情感障碍）与总体健康状况恶化相关。然而，对普通医院的入院情况几乎没有进行调查。我们试图描述SMI患者非精神病住院的频率和原因，并与同一地区的普通人群进行比较。伦敦东南部18380名年龄在20岁以上的SMI患者的记录与住院数据相关联。年龄和性别标准化入院率（SAR）是根据世界卫生组织国际疾病分类（ICD-10）第10版代码中的主要出院诊断计算的，参考地理流域数据。SMI队列中最常见的出院诊断类别为泌尿系统疾病、消化系统疾病、未分类症状、肿瘤和呼吸系统疾病。除了风险显著较低的肿瘤外，大多数主要类别的SAR均升高。中毒和外部原因、损伤、内分泌/代谢状况、血液学、神经学、皮肤学、感染和非特异性（“Z代码”）原因的住院风险特别高。出院时最常见的5个特定ICD-10诊断为“慢性肾衰竭”（N18）、非特定代码（Z 04）、“龋齿”（K 02）、“其他泌尿系统疾病”（N39）和“咽喉和胸部疼痛”（R 07），所有这些诊断均高于预期（SAR范围为1.57-6.66）。重度精神病患者非精神科住院的一系列原因是显而易见的，自我伤害、自我忽视和/或医疗服务减少以及医学上无法解释的症状是潜在的潜在解释。
Serious mental illness (SMI, including schizophrenia, schizoaffective disorder, and bipolar disorder) is associated with worse general health. However, admissions to general hospitals have received little investigation. We sought to delineate frequencies of and causes for non-psychiatric hospital admissions in SMI and compare with the general population in the same area. Records of 18 380 individuals with SMI aged ⩾20 years in southeast London were linked to hospitalisation data. Age- and gender-standardised admission ratios (SARs) were calculated by primary discharge diagnoses in the 10th edition of the World Health Organization International Classification of Diseases (ICD-10) codes, referencing geographic catchment data. Commonest discharge diagnosis categories in the SMI cohort were urinary conditions, digestive conditions, unclassified symptoms, neoplasms, and respiratory conditions. SARs were raised for most major categories, except neoplasms for a significantly lower risk. Hospitalisation risks were specifically higher for poisoning and external causes, injury, endocrine/metabolic conditions, haematological, neurological, dermatological, infectious and non-specific (‘Z-code’) causes. The five commonest specific ICD-10 diagnoses at discharge were ‘chronic renal failure’ (N18), a non-specific code (Z04), ‘dental caries’ (K02), ‘other disorders of the urinary system’ (N39), and ‘pain in throat and chest’ (R07), all of which were higher than expected (SARs ranging 1.57–6.66). A range of reasons for non-psychiatric hospitalisation in SMI is apparent, with self-harm, self-neglect and/or reduced healthcare access, and medically unexplained symptoms as potential underlying explanations.