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

这项拟议中的研究与患有严重精神疾病（SMI）的人有关，包括精神分裂症，情感障碍和双相情感障碍。重度精神障碍是对人们的生活产生重大影响的精神障碍。患有重度精神障碍的人自杀、事故、暴力、心脏病和中风的风险增加。SMIs对预期寿命的影响是巨大的，通常高于吸烟，糖尿病和肥胖症。我们的研究估计，患有SMI的人比普通人群早死10-15年。然而，其原因尚不清楚。尽管改善了医疗保健，但患有SMI的人仍然经常复发，功能能力下降。抗精神病药物是治疗SMI的主要药物，用于管理精神病症状，包括幻觉，妄想和不安的想法。抗精神病药物的有效性已在许多实验性临床试验中进行了评估;然而，已报告了许多不良反应，包括糖尿病，白色血细胞计数降低和心脏病。实验性临床试验也在理想条件下和相对较短的时间内进行。在实践中，抗精神病药物的使用方式多种多样，与试验中的测试方式不同。例如，通常不止一种抗精神病药物是处方或临床医生可能会切换药物或增加剂量，以努力最大限度地提高效益。目前，关于这些决策在现实临床环境中的风险和受益的信息非常有限。详细的电子病历提供了一个理想的数据来源，以调查在现实生活中使用抗精神病药物的风险和利益。南伦敦和莫兹利NHS基金会信托基金（SLAM）为4个伦敦行政区提供所有精神保健服务，是欧洲最大的此类提供者。自2006年以来，电子临床记录已在所有SLAM服务中使用，临床记录交互式搜索（CRIS）系统允许研究人员有效地从记录中搜索和检索匿名信息。目前CRIS系统中有超过180，000例病例，提供了我在以前的调查中使用的深入信息。目的：我的目的是调查抗精神病药物的概况（抗精神病药物的使用随时间的推移），并检查这些概况对精神健康，身体健康和死亡风险的影响。这将通过与常规死亡率追踪和死亡证明、常规医院护理信息和当地全科医疗数据集相关联的CRIS来实现，从而可以评估大量SLAM患者的初级、急诊和急性护理、死亡原因、身心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的身心健康后果的理解，以及它们在二级护理中的使用方式。这些信息将被证明是非常宝贵的临床实践，使临床医生作出更好的知情决定的风险和利益的常用药物。了解相关的风险，收益，服务使用和成本可以告知医疗保健政策，使卫生服务提供者能够更有效地利用现有资源，并协助NHS提供最高水平的患者护理。研究人员：作为奖学金申请人，我将在罗伯特·斯图尔特博士的监督下协调这个多学科团队的研究活动，并由伦敦国王学院精神病学研究所的马修·霍托夫教授指导。合作者将在各自领域提供专门知识和指导。

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.