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

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

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 myocardial infarction, 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。

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.