Risks, benefits and NHS costs associated with antipsychotic medications prescribed to individuals diagnosed with serious mental illness

这项拟议的研究与患有严重精神疾病(SMI)的人有关，包括精神分裂症、分裂情感障碍和双相情感障碍。自闭症是一种精神障碍，对人们的生活有实质性的影响。患有自闭症的人自杀、事故、暴力、心脏病和中风的风险增加。SMI对预期寿命的影响是巨大的，通常比吸烟、糖尿病和肥胖的影响更大。我们的研究估计，患有SMI的人比一般人早10-15年死亡。然而，造成这种情况的原因仍不清楚。尽管医疗保健有所改善，但患有SMI的人仍然经常复发，功能下降。抗精神病药物是SMI治疗的主要药物，用于控制精神病症状，包括幻觉、妄想和思维紊乱。抗精神病药物的有效性已经在许多实验性临床试验中进行了评估；然而，也有一些副作用被报道，包括糖尿病、白细胞计数降低和心脏病。此外，试验性临床试验是在理想的条件下进行的，时间相对较短。在实践中，抗精神病药物的使用方式多种多样，与试验中测试的方式不同。例如，通常会开出一种以上的抗精神病药物，或者临床医生可能会更换药物或增加剂量，以努力使益处最大化。目前，关于这些决定在现实生活中临床环境中的风险和好处的信息非常有限。详细的电子患者记录为调查现实生活中与抗精神病药物使用相关的风险和好处提供了理想的数据来源。南伦敦和莫德斯利NHS基金会信托基金(SLAM)为伦敦4个行政区提供所有精神卫生保健，是欧洲最大的此类机构。自2006年以来，所有SLAM服务都使用了电子临床记录，临床记录交互搜索(CRIS)系统使研究人员能够有效地从记录中搜索和检索匿名信息。目前在CRIS系统中有超过18万个病例提供了我在以前的调查中使用的深入信息。目的：我的目标是调查抗精神病药物的概况(随着时间的推移抗精神病药物的使用)，并检查这些概况对SMI患者的心理健康、身体健康和死亡风险的影响。这将利用CRI与常规死亡追踪和死亡证书、常规医院护理信息和当地全科医疗数据集相关联，从而能够评估一大群患有SMIS的SLAM患者的初级、紧急和急性护理、死亡原因、身体和心理健康结果以及相关费用。影响：这项研究将提高我们对抗精神病药物对身心健康的影响以及它们在二级护理中的使用方式的理解。这些信息将被证明对临床实践非常有价值，使临床医生能够就常用药物的风险和好处做出更明智的决定。了解相关的风险、好处、服务使用和成本可以为医疗政策提供信息，使医疗服务提供商能够更有效地利用现有资源，并帮助NHS提供最高水平的患者护理。研究人员：作为奖学金申请者，我将在Robert Stewart博士的监督下，在伦敦精神病学研究所国王学院Matthew Hotopf教授的指导下，协调这个多学科团队的研究活动。合作者将在各自的领域提供专业知识和指导。

The proposed research is relevant to people experiencing serious mental illnesses (SMI) including schizophrenia, schizoaffective disorder and bipolar affective disorder. SMIs are mental disorders which have a substantial impact on people's lives. Those with SMIs are at increased risk of suicide, accidents, violence, heart disease and stroke. The impact of SMIs on life expectancy is substantial and generally higher than that of smoking, diabetes and obesity. Our research has estimated that individuals with SMI die between 10-15 years earlier than the general population. However, reasons for this remain unclear. Despite improving healthcare, people with SMIs continue to have frequent relapses and reduced ability to function. Antipsychotic medications, a mainstay of treatment for SMIs, are used to manage psychotic symptoms, including hallucinations, delusions and disturbed thoughts. The effectiveness of antipsychotic medications has been assessed in numerous experimental clinical trials; however, a number of adverse effects have been reported, including, diabetes, lowered white blood cell count and heart disease. Also experimental clinical trials are performed under ideal conditions and over relatively short time periods. In practice, antipsychotics are used in a variety of ways that differ from how they are tested in trials. For example, often more than one antipsychotic is prescribed or clinicians may switch medications or increase the dose in an effort to maximise the benefit. Currently, there is very limited information on the risks and benefits of these decisions in real-life clinical settings. Detailed electronic patient records provide an ideal source of data to investigate the risks and benefits associated with antipsychotic medication use in real-life. The South London and Maudsley NHS Foundation Trust (SLAM) provides all mental healthcare to 4 London boroughs and is the largest such provider in Europe. Electronic clinical records have been used across all SLAM services since 2006, and the Clinical Record Interactive Search (CRIS) system allows researchers to search and retrieve anonymised information from the records efficiently. There are currently over 180,000 cases in the CRIS system providing in-depth information which I have used in previous investigations.Aims: My aim is to investigate antipsychotic profiles (antipsychotic use over time) and examine the impact of these profiles on the mental health, physical health and risk of mortality in people with SMIs. This will be achieved using CRIS linked to routine mortality tracing and death certificates, routine hospital care information and a local General Practice dataset making it possible to assess primary, emergency and acute care, causes of mortality, physical and mental health outcomes and associated costs for a large group of SLAM patients with SMIs. Impact: This research will improve our understanding of the physical and mental health consequences of antipsychotic medications and the ways in which they are used in secondary care. This information would prove invaluable for clinical practice allowing clinicians to make better informed decisions regarding the risks and benefits of commonly used medications. Understanding associated risks, benefits, service use and costs can inform healthcare policy, allow health service providers to make more effective use of available resources and assist the NHS in providing the highest level of patient care. Researchers: As the fellowship applicant, I will coordinate the study activities in this multidisciplinary team under the supervision of Dr Robert Stewart, and mentored by Professor Matthew Hotopf at Kings Collage London, Institute of Psychiatry. The collaborators will contribute expertise and guidance in their respective fields.