嚴重精神病患的主要死亡診斷

Major Causes of Mortality among Patients with Severe Psychotic Disorders

嚴重精神病患由於認知功能不佳，缺乏自我健康管理，菸酒癮等物質濫用高於一般人，加上抗精神病藥物的長期副作用，預期平均壽命較一般人短，研究的目的是探討嚴重精神病患死亡診斷，作為提升醫療品質的參考。本研究是以查閱病歷同時參考每月死亡個案討論會的紀錄，整理台灣東部某精神專科醫院，從2005年1月1日至2009年12月31日，所有死亡個案的相關資料。死亡個案總計216人，男女比例分別為73.6%、26.4%；男性平均死亡年齡61.48歲，女性平均死亡年齡60.81歲，總體平均死亡年和一般大眾的平均餘命差距5.87歲至8.89歲。死亡診斷排行前三名依次為感染及敗血症、意外事故、心臟疾病。感染及敗血症的原因中以肺炎最多。意外事故死亡以異物哽塞居首；心臟疾病的死亡診斷以心肌梗塞最多。本研究顯示嚴重精神病患要死亡的診斷為感染症，這類弱勢族群醫療需求的優先性和一般大眾並不相同。

Introduction. It is generally believed that the decreased life spans of patients with severe psychotic disorders are largely due to poor self-care, poor physical constitution, substance abuse, and the adverse effects of psychotropic medication such as cardiomyopathy, metabolic syndrome and food choking, though little research has been performed to assess this in certain populations. Methods. We reviewed the medical documents of mortality at a large psychiatric hospital in eastern Taiwan from 2005 to 2009 in order to identify the major causes of mortality in this patient group. Results. The number of total deaths was 216 (73.6% male and 26.4% female). Average age of death of male patient was 61.48 years old and female’s 60.81 years old. The difference in average age of death between patients with severe psychotic disorders and general population ranged from 5.87 to 8.89 years. The leading causes of mortality are (1) infection with or without sepsis, (2) accidents, and (3) heart diseases. Most of the deaths could be attributed to infection associated with pneumonia with or without sepsis. The leading cause of accidental deaths was food choking. Most of the cardiac deaths resulted from acute myocardial infarction. Conclusion. Infection was the leading cause of mortality among the severe psychotic patients in this study. Priorities of medical care of severe psychotic patients may differ from those required for general population. (J Med Health. 2016;5(1):93-100)