氯氮平、锂和丙戊酸盐对精神分裂症和双相情感障碍患者的抗自杀效果：一项现实世界的全国性研究

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research Pub Date : 2025-03-26 DOI:10.1016/j.jpsychires.2025.03.045

Junhee Lee , Jiseun Lim , Se Hyun Kim , Jaewon Kim , Kwang Ho Mun , Jiwon Kang

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引用次数: 0

摘要

尽管精神治疗取得了进步，但精神分裂症（SZ）和双相情感障碍（BD）患者的自杀率仍然高得惊人。氯氮平、锂和丙戊酸盐是可能降低这些人群自杀率的药物，但证据有限且常常不一致。本研究旨在利用韩国全国健康保险数据库评估这些药物的抗自杀效果。使用国家卫生信息数据库的数据进行回顾性队列研究。该研究纳入了2007年至2010年间诊断为SZ的102540例患者和BD的96336例患者。我们评估了自杀死亡率与近期氯氮平、锂、丙戊酸盐以及其他精神药物处方之间的关系。自杀风险比（HR）采用时间相关Cox回归分析计算。SZ的自杀率为每10万人年308.0人，BD为285.1人。调整混杂因素后，处方锂和丙戊酸盐与SZ的自杀风险比显著降低相关(锂的风险比：0.58,95% CI: 0.46-0.72；丙戊酸盐的HR: 0.61, 95% CI: 0.52-0.71)和BD(锂的HR: 0.54, 95% CI: 0.44-0.65；丙戊酸的HR: 0.66, 95% CI: 0.57-0.76)。氯氮平与SZ患者较低的自杀风险相关，但仍无统计学意义。锂和丙戊酸盐在SZ和BD患者中具有显著的抗自杀作用，强调了情绪稳定剂在其中预防自杀的潜在作用。

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Anti-suicidal effectiveness of clozapine, lithium, and valproate in patients with schizophrenia and bipolar disorder: A real-world nationwide study

Despite advances in psychiatric treatment, individuals with schizophrenia (SZ) and bipolar disorder (BD) continue to experience alarmingly high suicide rates. Clozapine, lithium, and valproate are medications that may potentially reduce suicide in these populations, but evidence is limited and often inconsistent. This study aimed to evaluate the anti-suicidal effectiveness of these medications using a nationwide health insurance database in South Korea.

A retrospective cohort study was conducted using data from the National Health Information Database. This study included 102,540 patients with SZ and 96,336 patients with BD diagnosed between 2007 and 2010. We assessed the association between suicide mortality and recent prescriptions of clozapine, lithium, and valproate, as well as other psychotropic drugs. Suicide hazard ratios (HR) were calculated using a time-dependent Cox regression analysis.

Suicide rates per 100,000 person-years were 308.0 for SZ and 285.1 for BD. After adjustment for confounders, lithium and valproate prescriptions were associated with significantly lower suicide hazard ratios in both SZ (HR of lithium: 0.58, 95 % CI: 0.46–0.72; HR of valproate: 0.61, 95 % CI: 0.52–0.71) and BD (HR of lithium: 0.54, 95 % CI: 0.44–0.65; HR of valproate: 0.66, 95 % CI: 0.57–0.76). Clozapine was associated with a lower suicide hazard in patients with SZ but remained statistically non-significant.

Lithium and valproate have significant anti-suicidal effects in patients with SZ and BD, underscoring the potential role of mood stabilizers in suicide prevention among them.

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来源期刊

Journal of psychiatric research 医学-精神病学

CiteScore

7.30

自引率

2.10%

发文量

622

审稿时长

130 days

期刊介绍： Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research: (1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors; (2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology; (3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;