Sudden unexpected death in schizophrenia: Autopsy findings in psychiatric inpatients
Sudden unexpected death in schizophrenia: Autopsy findings in psychiatric inpatients
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DOI：
10.1016/j.schres.2014.03.011
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发表时间：
2014-05-01
影响因子：
4.5
通讯作者：
Manu, Peter
中科院分区：
文献类型：
--
作者：
Ifteni, Petru;Correll, Christoph U.;Manu, Peter
精神分裂症与过早死亡和高比率的突然意外死亡有关。尸检数据很少，在使用死亡证明或根本原因评估的研究中，大多数猝死仍然无法解释。在社区，尸检数据表明，突然"自然"死亡的最常见原因是冠状动脉疾病。在这项研究中，我们使用尸检结果来确定1989年至2013年在一家独立的精神病教学医院住院的7189名精神分裂症患者的连续队列中猝死的原因。病历审查确定了57名患者（0.79%）在住院期间突然意外死亡。对51例（89.5%）患者（55.9 ± 9.4岁，男性= 56.9%）进行了尸检。基于尸检的猝死原因最常见的是心血管疾病（62.8%）。具体原因包括心肌梗死（52.9%）、肺炎（11.8%）、气道阻塞（7.8%）、心肌炎（5.9%）、扩张型心肌病、心包积血、肺栓塞、出血性卒中和脑肿瘤（各2.0%）。6例（11.8%）猝死原因不明，其中3例尸检有冠状动脉粥样硬化证据。有和无心肌梗死的患者在年龄、性别、吸烟、体重指数和精神治疗方面相似（p值>= 0.10）。总之，在精神病医院心脏性猝死的发生率为0.8%，远高于一般人群的发生率。尸检结果表明，精神分裂症的猝死是由结构性心血管、呼吸和神经系统异常引起的，大多数病例是由于急性心肌梗死。冠状动脉疾病的早期识别和治疗必须成为所有成年精神分裂症患者的临床优先事项。(C)2014爱思唯尔有限公司版权所有。
Schizophrenia is associated with premature mortality and a high rate of sudden, unexpected deaths. Autopsy data are scant, and in studies using death certificates or root cause assessments, a majority of sudden deaths remained unexplained. In the community, post-mortem data indicate that the most common cause of sudden "natural" death is coronary artery disease. In this study, we used autopsy findings to determine the cause of sudden death in a consecutive cohort of 7189 schizophrenia patients admitted to a free-standing, psychiatric teaching hospital from 1989 to 2013. Medical record review identified 57 patients (0.79%) who died suddenly and unexpectedly during hospitalization. Autopsies were performed in 51 (89.5%) patients (55.9 +/- 9.4 years, male = 56.9%). Autopsy-based causes of sudden death were most commonly cardiovascular disorders (62.8%). Specific causes included myocardial infarction (52.9%), pneumonia (11.8%), airway obstruction (7.8%), myocarditis (5.9%), and dilated cardiomyopathy, hemopericardium, pulmonary embolus, hemorrhagic stroke and brain tumor (2.0% each). The sudden death remained unexplained in 6 (11.8%) patients, 3 of whom had evidence of coronary arteriosclerosis on autopsy. Patients with and without myocardial infarction were similar regarding age, gender, smoking, body mass index and psychotropic treatment (p values >= 0.10). In conclusion, sudden cardiac death occurs at a 0.8% rate in a psychiatric hospital, well above general population rates. Autopsy findings indicate that sudden death in schizophrenia is caused by structural cardiovascular, respiratory and neurological abnormalities, with most cases due to acute myocardial infarction. Early recognition and treatment of coronary artery disease must become a clinical priority for all adults with schizophrenia. (C) 2014 Elsevier B.V. All rights reserved.