鎮靜與安眠藥物可能增加老年病患自殺風險

出處：WebMD醫學新聞

　　June 4, 2009 — 根據一項線上發表於6月號BMC老年學的病例控制研究結果，鎮靜與安眠藥物可能增加老年病患自殺風險。
　　
　　來自瑞典哥特堡哥特堡大學的Anders Carlsten與Margda Waern指出，當抗憂鬱藥物造成自殺是用於年輕族群的一個考量時，許多的證據顯示這些藥物可能造成老年病患自殺。有關於其他精神疾病藥物與自殺的關係，結果是不一致的。鎮靜與安眠藥物被廣泛地處方給老年憂鬱、焦躁及睡眠障礙的病患。
　　
　　這項研究的目的在於評估特定種類的精神疾病藥物，在控制適當的適應症後，與老年病患自殺風險之間的關係。在哥特堡與兩個鄰近國家，研究者們進行了一項針對85位65歲以上老年自殺病患與153位控制組受試者的病例控制研究，這些受試者來自一個以群眾為基礎的比較組。
　　
　　在85個自殺病例中，46位為男性、39位是女性；平均年齡為75歲。精神學專家訪談自殺病患的家屬，而控制組受試者也經由面對面的訪談評估。病例病患與控制組受試者的初級照護及精神科病歷記錄也接受評估，分析所有可獲得的資料使得他們能根據精神異常診斷與統計手冊第四版的標準診斷過去一個月發生的精神異常。
　　
　　未經校正的分析結果顯示，使用抗憂鬱藥物、抗精神分裂藥物、鎮靜及安眠藥物都與自殺風險增加有關，但是在校正情感與焦慮異常後，破壞了抗憂鬱藥物和其中選擇性血清素再回收抑制劑與自殺風險之間的關係。
　　
　　在未經校正的分析中，使用鎮靜藥物與自殺風險上升14倍有關，且這個效應即使在校正任何基於精神異常診斷與統計手冊第四版的標準後仍然是獨立的危險因子。在校正模式中，有處方安眠藥物與自殺風險上升四倍有關。
　　
　　這項研究的限制包括無法確認自殺方式對於自殺風險的影響、樣本數目太小、根據近親訪談得到的數據進行診斷。
　　
　　研究作者們寫到，鎮靜和安眠藥物都與自殺風險上升有關，即使校正了適當適應症後這個關係仍然存在。有鑑於這些藥物處方非常的多，當要開立鎮靜安眠藥物給老年病患時，都應該進行仔細的自殺風險評估。
　　
　　瑞典健康照護科學與過敏研究基金會、瑞典社會研究會議、瑞典研究會議贊助這項研究。研究作者們表示沒有相關資金上的往來。

Sedatives and Hypnotics May Increase Risk for Suicide in Elderly Patients

Medscape Medical News

June 4, 2009 — Sedatives and hypnotics may increase the risk for suicide in elderly patients, according to the results of a case-control study reported online in the June issue of BMC Geriatrics.

"While antidepressant-induced suicidality is a concern in younger age groups, there is mounting evidence that these drugs may reduce suicidality in the elderly," write Anders Carlsten and Margda Waern, from Gothenburg University in Gothenburg, Sweden. "Regarding a possible association between other types of psychoactive drugs and suicide, results are inconclusive. Sedatives and hypnotics are widely prescribed to elderly persons with symptoms of depression, anxiety, and sleep disturbance."

The aim of this study was to evaluate the association of specific types of psychoactive drugs with suicide risk in late life, after controlling for appropriate indications. In Gothenburg and 2 adjacent counties, the investigators performed a case-control study of 85 patients 65 years or older who had committed suicide matched with 153 control subjects from a population-based comparison group.

Of the 85 suicide cases, 46 were men and 39 were women; mean age was 75 years. A psychiatrist interviewed close informants for the patients who had committed suicide, and control subjects were also interviewed face-to-face. Primary care and psychiatric records were also reviewed for case patients and control subjects, and analysis of all available data allowed diagnosis of past-month mental disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

Unadjusted analysis showed that use of antidepressant, antipsychotic, sedative, and hypnotic drugs were all associated with an increased risk for suicide, but adjusting for affective and anxiety disorders abolished this association for antidepressants in general and for selective serotonin-reuptake inhibitors. Adjustment for psychotic disorders abolished the association of antipsychotic use.

In the unadjusted analyses, use of sedatives was associated with nearly a 14-fold increase of suicide risk, and this persisted as an independent risk factor for suicide even after adjusting for any disorder based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. In the adjusted model, having a current prescription for a hypnotic was associated with a 4-fold increase in suicide risk.

Limitations of this study include inability to determine causality or the contribution of availability of suicide means on suicide risk, small sample size, and diagnoses of the patients who had committed suicide based on data obtained by proxy interviews.

"Sedatives and hypnotics were both associated with increased risk for suicide after adjustment for appropriate indications," the study authors write. "Given the extremely high prescription rates, a careful evaluation of the suicide risk should always precede prescribing a sedative or hypnotic to an elderly individual."

The Swedish Foundation for Health Care Science and Allergy Research, the Swedish Council for Social Research, and the Swedish Research Council supported this study. The study authors have disclosed no relevant financial relationships.

BMC Geriatr. 2009;9:20.