Comorbid Substance Abuse and Long-Term Health Outcomes in Schizophrenia

描述（由申请人提供）：本项目将研究药物滥用（SA）对严重精神疾病相关的长期健康发病率和死亡率的影响。具体目标是：1）将850多名患有严重精神疾病和SA的患者样本与850多名患有严重精神疾病的非滥用者样本进行比较，并检查14年内的医疗合并症和死亡率，特别是HIV和传染病，心血管疾病，肝病，血栓栓塞事件，糖尿病，心血管疾病，呼吸系统疾病，恶性肿瘤和自杀; 2）检查初始治疗期间人口统计学（年龄、种族、性别）和临床变量（疾病严重程度、药物滥用严重程度和持续时间、体重、血压、血糖、血脂、吸烟史和抗精神病药物治疗）对医学发病率和死亡率风险的影响。该病例队列设计将对1，701例具有详细临床数据的估计样本（243例死亡，1458例对照）中每例死亡检查6例病例。生存分析将检查SA对至死亡时间的影响。这些模型将用于估计物质使用者与非使用者之间总死亡率的未调整和年龄调整的风险比，总体和诊断，并将使用相互作用项来探索这些风险比是否因种族和性别而异。将检查病因特异性死亡率以及SA是否改变与基线临床病史相关的预后。精神病和SA的负担非常高。传统上，这些疾病被视为独立发生的疾病进行治疗和研究，然而，大约一半的精神疾病患者同时患有SA;患病率比一般人群高得多。在患有严重精神疾病和药物滥用疾病的人中，合并的医学疾病和发病率增加。然而，很少有研究已经做了比较长期的发病率和死亡率的精神病患者和没有共病SA。如果对双重诊断的患者进行靶向治疗，与SA相关的特定发病率和死亡率可能是可以预防的。具体的风险因素和基线健康指数可能表明风险更大，这将是对滥用药物和酒精的严重精神疾病患者的未来治疗和研究以及确定干预领域的宝贵信息。在精神分裂症和药物滥用障碍患者中，合并发生的医学疾病和发病率增加。与这两种疾病相关的负担非常高。通过更好地了解药物滥用对精神分裂症发病率和死亡率的影响，可以围绕本项目工作确定的结果和风险因素，提出关于教育、政策和未来干预措施的具体建议。这将是改善精神分裂症患者生活的重要一步。

DESCRIPTION (provided by applicant): This project will examine the effects of substance abuse (SA) on the long-term health morbidity and mortality associated with severe mental illness. The specific aims are to 1) compare a sample of over 850 people with severe mental illness and SA to a sample of over 850 nonabusers with severe mental illness and examine medical comorbidity and mortality over 14 years, specifically for HIV and infectious disease, cardiovascular disease, liver disease, thromboembolic events, diabetes, cardiovascular disease, respiratory disorders, malignant neoplasms and suicide and to 2) examine the effects of demographic (age, race, sex) and clinical variables during initial treatment (severity of illness, severity and duration of substance abuse, weight, blood pressure, glucose, lipids, smoking history and antipsychotic treatment) to the risk of medical morbidity and mortality. This case-cohort design will examine 6 cases per each death for an estimated sample of 1,701 cases with detailed clinical data (243 deaths, 1458 controls). Survival analyses will examine the effects of SA on time to death. These models will be used to estimate unadjusted and age-adjusted risk ratios for total mortality among substance users versus non-users, overall and by diagnosis, and will use interaction terms to explore whether these risk ratios differ by race and gender. Cause-specific mortality and whether SA modifies the prognosis associated with baseline clinical history will be examined. The burdens of psychosis and SA are extremely high. Traditionally these illnesses have been treated and researched as if they occur independently, however approximately half of all people with mental illness have co-occurring SA; a much higher prevalence than the general population. Co-occurring medical disorders and morbidity are increased among people with severe mental illness and substance abuse disorders. However, very little research has been done to compare long-term morbidity and mortality in psychotic patients with and without comorbid SA. Specific morbidities and mortality associated with SA may be preventable if targeted treatments are available for dually diagnosed patients. Specific risk factors and baseline health indices may be indicative of a greater risk and this would be invaluable information to the future of treatment and research for people with severe mental illness who abuse drugs and alcohol as would identifying areas for intervention. Co-occurring medical disorders and morbidity are increased among people with schizophrenia and substance abuse disorders. The burdens associated with both these disorders are extremely high. By better understanding the impact of substance abuse on morbidity and mortality in schizophrenia, specific recommendations for education, policy and future interventions can be built around the outcomes and risk factors defined by the work of this project. This will be an important step for improving the lives of people with schizophrenia.