Excess Mortality, Risk of Acute Myocardial Infarction, and Related Medical Care Receipts in People with Serious Mental Illness

嚴重精神疾病病人較高的死亡率與心肌梗塞風險及相關醫療處置

吳書儀(Shu-I Wu)；陳錦宏(Vincent Chin-Hung Chen)；Robert Stewart

schizophrenia ； bipolar disorder ； risk ； acute myocardial infarction ； 思覺失調症 ； 雙相情緒障礙症 ； 風險 ； 急性心肌梗塞

台灣精神醫學

31卷1期（2017 / 03 / 01）

25 - 37+i

英文

People with serious mental illness (SMI, including schizophrenia and bipolar disorder) experience adverse health and premature mortality. Higher incidence or worse outcomes of acute myocardial infarction (AMI), and antipsychotic exposures, may partly underlie this. In this overview, we are exploring whether the relative risk of AMI in people with SMI are higher than general population. Intervention receipts of invasive cardiac care and inpatient mortality between people with or without SMI are compared. Possible associations between the risk of AMI and use of antipsychotic agents are elaborated. We summarize (A) overall, no increased risk of AMI has been found in people with SMI, apart from in sub-group analyses (suggesting an excess SMI-associated risk in younger women); (B) Patients with schizophrenia and bipolar disorder are less than half as likely to receive invasive coronary interventions following AMI episode compared to controls; (C) Inpatient mortality was higher in patients with schizophrenia compared to controls. Potential public health, clinical, and research implications are also discussed at the end of this overview.

罹患嚴重精神疾病（serious mental illness，SMI，包括思覺失調和雙相情緒障礙症）不僅受精神症狀影響須要長期照護，同時也比一般人口罹患較高的身體疾病共病症 (comorbidity)，約兩至三倍較高的死亡率、以及減少約10 至15 年的預期壽命。較一般人口為高的心血管疾病盛行率 (odds ratio = 1.1 - 1.8) 可能是其中之一原因。但關於急性心肌梗塞 (acute myocardialinfarction, AMI) 在 SMI 病人上的疾病風險、得到 AMI 後所接受到的醫療處置、以及與抗精神病藥物的關係則較少被探討。在本文中，我們探討了在SMI 病人中AMI 的相對危險度是否高於一般人群的相關文獻，比較有無 SMI 的病人在得到 AMI 後所接受到的醫療處置以及後續死亡率是否有差異，同時並闡述抗精神病藥的使用 AMI 的風險與之間的可能關聯。我們總結：(A) 總體來說，除了在部分族群（例如在年輕SMI 女性，罹患AMI 的風險較一般族群年輕女性高），整體在SMI 病人中沒有發現較高罹患AMI 的風險。(B) 與一般族群相比，思覺失調和雙極性情感疾患患者在 AMI 發作後接受侵入性冠狀動脈介入治療的可能性不到一半，同時思覺失調症病人的住院死亡率高於對照組。

1. Abrams, TE,Vaughan-Sarrazin, M,Rosenthal, GE(2009).Psychiatric comorbidity and mortality after acute myocardial infarction.Circ Cardiovasc Qual Out- comes,2,213-220.
2. Angst, F,Stassen, HH,Clayton, PJ,Angst, J(2002).Mortality of patients with mood disorders: follow-up over 34- 38 years.J Affect Disord,68,167-181.
3. Bak, M,Fransen, A,Janssen, J,van Os, J,Drukker, M(2014).Almost all antipsychotics result in weight gain: a meta-analysis.PLOS One,9,e94112.
4. Bresee, LC,Majumdar, SR,Patten, SB,Johnson, JA(2010).Prevalence of cardiovascular risk factors and disease in people with schizophrenia: a population-based study.Schizophr Res,117,75-82.
5. Callaghan, RC,Boire, MD,Lazo, RG,McKenzie, K,Cohn, T(2009).Schizophrenia and the incidence of cardiovascular morbidity: a population-based longitudinal study in Ontario, Canada.Schizophr Res,115,325-332.
6. Callaghan, RC,Khizar, A(2009).The incidence of cardiovascular morbidity among patients with bipolar disorder: a population-based longitudinal study in Ontario, Canada.J Affect Disord,122,118-123.
7. Chang, CK,Hayes, RD,Broadbent, M(2010).All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study.BMC Psychiatry,10,77.
8. Chang, CK,Hayes, RD,Perera, G(2011).Life expec- tancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London.PLOS One,6,e19590.
9. Curkendall, SM,Mo, J,Glasser, DB,RoseStang, M,Jones, JK(2004).Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada.J Clin Psychiatry,65,715-720.
10. Dickey, B,Normand, SL,Weiss, RD,Drake, RE,Azeni, H(2002).Medical morbidity, mental illness, and substance use disorders.PsychiatrServ,53,861-867.
11. DiMatteo, MR,Lepper, HS,Croghan, TW(2000).Depression is a risk factor for noncompliance with medical treat- ment: meta-analysis of the effects of anxiety and de- pression on patient adherence.Arch Intern Med,160,2101-2017.
12. Druss, BG,Bradford, DW,Rosenheck, RA,Radford, MJ,Krumholz, HM(2000).Mental disorders and use of cardiovascular procedures after myocardial infarction.JAMA,283,506-511.
13. Druss, BG,Bradford, WD,Rosenheck, RA,Radford, MJ,Krumholz, HM(2001).Quality of medical care and excess mortality in older patients with mental disorders.Arch Gen Psychiatry,58,565-572.
14. Druss, BG,Rosenheck, RA(1998).Mental disorders and access to medical care in the United States.Am J Psychiatry,155,1775-1777.
15. Eldridge, D,Dawber, N,Gray, R(2011).A well-being support program for patients with severe mental illness: a service evaluation.BMC Psychiatry,11,46.
16. Goff, DC,Sullivan, LM,McEvoy, JP(2005).A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls.Schizophr Res,80,45-53.
17. Graber, MA,Bergus, G,Dawson, JD,Wood, GB,Levy, BT,Levin, I(2000).Effect of a patient's psychiatric history on physicians’ estimation of probability of disease.J Gen Intern Med,15,204-206.
18. Harris EC,Barraclough B(1998).Excess mortality of mental disorder.Br J Psychiatry,173,11-53.
19. Horvitz-Lennon, M,Kilbourne, AM,Pincus, HA(2006).From silos to bridges: meeting the general health care needs of adults with severe mental illnesses.Health Aff,25,659-669.
20. Kilbourne, AM,Cornelius, JR,Han, X(2004).Burden of general medical conditions among individuals with bipolar disorder.Bipolar Disord,6,368-373.
21. Kisely, S,Lin, E,Lesage, A(2009).Use of administrative data for the surveillance of mental disorders in 5 provinces.Can J Psychiatry,54,571-575.
22. Kisely, S,Preston, N,Xiao, J,Lawrence, D,Louise, S,Crowe, E(2013).Reducing all-cause mortality among patients with psychiatric disorders: a population-based study.CMAJ,185,E50-E56.
23. Kisely, S,Smith, M,Lawrence, D,Maaten, S(2005).Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia.Br J Psychiatry,187,552-558.
24. Kurdyak, P,Vigod, S,Calzavara, A,Wodchis, WP(2012).High mortality and low access to care following incident acute myocardial infarction in individuals with schizophrenia.Schizophr Res,142,52-57.
25. Lahti, M,Tiihonen, J,Wildgust, H(2012).Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia.Psychol Med,42,2275-2285.
26. Lambert, TJ,Newcomer, JW(2009).Are the cardiometabolic complications of schizophrenia still neglected? barriers to care.Med J Aust,190,S39-S42.
27. Laursen, TM,Munk-Olsen, T,Agerbo, E,Gasse, C,Mortensen, PB(2009).Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder.Arch Gen Psychiatry,66,713-720.
28. Laursen, TM,Munk-Olsen, T,Gasse, C(2011).Chronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder.PLOS One,6,e24597.
29. Lawrence, D,Jablensky, AV,Holman, CD,Pinder, TJ(2000).Mortality in Western Australian psychiatric patients.Soc Psychiatry Psychiatr Epidemiol,35,341-347.
30. Lawrence, DM,Holman, CD,Jablensky, AV,Hobbs, MS(2003).Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980-1998.Br J Psychiatry,182,31-36.
31. Lin, CW,Yen, ST,Chang, HT(2010).Loss of cofilin 1 disturbs actin dynamics, adhesion between enveloping and deep cell layers and cell movements during gastrulation in zebrafish.PLOS One,5,e15331.
32. Lin, HC,Tsai, SY,Lee, HC(2008).No higher risk of myocardial infarction among bipolar patients in a 6-year follow-up of acute mood episodes.Psychosom Med,70,73-76.
33. Martin, DJ,Ul-Haq, Z,Nicholl, BI(2016).Cardiometabolic disease and features of depression and bipolar disorder: population-based, cross-sectional study.Br.J Psychiatry,208,343-351.
34. Mitchell, AJ,Lawrence, D(2011).Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis.Br J Psychiatry,198,434-441.
35. Mitchell, AJ,Malone, D,Doebbeling, CC(2009).Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies.Br J Psychiatry,194,491-499.
36. Osborn, DP,Baio, G,Walters, K(2011).Inequalities in the provision of cardiovascular screening to people with severe mental illnesses in primary care Cohort study in the United Kingdom THIN Primary Care Database 2000-2007.Schizophr Res,129,104-110.
37. Osborn, DP,Levy, G,Nazareth, I,Petersen, I,Islam, A,King, MB(2007).Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's General Practice Rsearch Database.Arch Gen Psychiatry,64,242-249.
38. Osby, U,Brandt, L,Correia, N,Ekbom, A,Sparen, P(2001).Excess mortality in bipolar and unipolar disorder in Sweden.Arch Gen Psychiatry,58,844-850.
39. Pan, C,Kuo, CJ,Chen, CC,Hu, WH(1998).Mortality in acute inpatients at a psychiatric hospital.Taiwanese Journal of Psychiatry,12,120-129.
40. Petersen, LA,Normand, SL,Druss, BG,Rosenheck, RA(2003).Process of care and outcome after acute myocardial infarction for patients with mental illness in the VA health care system: are there disparities?.Health Services Research,38,41-63.
41. Robson, D,Gray, R(2007).Serious mental illness and physical health problems: a discussion paper.Int J Nurs Stud,44,457-466.
42. Sokal, J,Messias, E,Dickerson, FB(2004).Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services.J NervMent Dis,192,421-427.
43. Truyers, C,Buntinx, F,De Lepeleire, J(2011).Incident somatic comorbidity after psychosis: results from a retrospective cohort study based on Flemish general practice data.BMC FamPract,12,132.
44. Tsai, S,Yau, YJ.,Kuo, CJ.,Chen, CC.,Lee, HC.(2000).Risk factors for mortality in bipolar disorder.Taiwanese Journal of Psychiatry,14,290-300.
45. World Health Organization(2003).The Global Burden of Disease.Geneva:WHO.
46. World Health Organization(2008).The Global Burden of Disease: 2004 Update.Geneva:World Health Organization.
47. Wu, SI,Chen, SC,Juang, JJ(2013).Diagnostic procedures, revascularization, and inpatient mortality after acute myocardial infarction in patients with schizophrenia and bipolar disorder.Psychosom Med,75,52-59.
48. Wu, SI,Chen, SC,Liu, SI(2015).Relative risk of acute myocardial infarction in people with schizophrenia and bipolar disorder: a population-based cohort study.PLOS One,10,e0134763.
49. Young, JK,Foster, DA(2000).Cardiovascular procedures in patients with mental disorders.JAMA,283,3198-3199.

1. 游淑真(2017)。從旋轉門效應來看精神疾患者的社區照顧服務。社會工作實務與研究學刊，5，59-98。