精神分裂症与大多数自然原因导致的过早死亡有关。认知功能下降已被确定为一般人群死亡率的决定因素。然而,对精神分裂症患者这一问题的前瞻性研究很少。
■研究认知功能低下是否是精神分裂症患者自然死亡的危险因素。
这项前瞻性队列研究包括在1999年2月1日至2022年12月31日之间在巴尔的摩的非营利性精神病系统中注册的精神分裂症或分裂情感障碍患者。马里兰。使用可重复电池评估神经心理学状态(RBANS)和其他临床措施对参与者进行评估。
■自然原因死亡率。
■认知功能的关联,肥胖,吸烟,使用Cox比例风险回归模型评估具有自然原因死亡率的医疗条件.
■在844名参与者中(平均[SD]年龄,39.6[12.1]岁;533名男性[63.2%]),158人(18.7%)在14.4年的中位随访期间死于自然原因(范围,7.0天至23.9年)。与死亡率相关的最重要因素是RBANS测量的认知功能降低(Cox系数,-0.04;95%CI,-0.05至-0.03;z=-5.72;调整后P<.001)。与死亡率独立相关的其他因素包括自身免疫性疾病的诊断(风险比[HR],2.86;95%CI,1.83-4.47;z=4.62;调整后P<.001),吸烟(HR,2.26;95%CI,1.55-3.30;z=4.23;调整后P<.001),慢性阻塞性肺疾病的诊断(HR,3.31;95%CI,1.69-6.49;z=3.48;调整后P=.006),作为连续变量的体重指数(HR,1.06;95%CI,1.02-1.09;z=3.30;调整后P=0.01),心律紊乱的诊断(HR,2.56;95%CI,1.40-4.69;z=3.06;调整后P=.02),离婚或分居(HR,1.80;95%CI,1.22-2.65;z=2.97;调整后P=.02)。低于第50百分位数的RBANS分数显示出与吸烟者的联合关联,体重指数升高,并被诊断为自身免疫性或心脏节律紊乱。
■在这项前瞻性队列研究中,认知功能低下是精神分裂症患者自然死亡的危险因素.应该努力改善认知功能的方法,特别是在有额外风险因素的个体中。
UNASSIGNED: Schizophrenia is associated with premature mortality from mostly natural causes. Decreased cognitive functioning has been identified as a determinant of mortality in the general population. However, there have been few prospective studies of this issue in persons with schizophrenia.
UNASSIGNED: To examine whether lower cognitive functioning is a risk factor for natural cause mortality in schizophrenia.
UNASSIGNED: This prospective cohort study included persons with schizophrenia or schizoaffective disorder enrolled between February 1, 1999, and December 31, 2022, at a nonprofit psychiatric system in Baltimore, Maryland. Participants were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and other clinical measures.
UNASSIGNED: Natural cause mortality.
UNASSIGNED: Associations of cognitive function, obesity, tobacco smoking, and medical conditions with natural cause mortality were evaluated using Cox proportional hazards regression models.
UNASSIGNED: Of the 844 participants enrolled (mean [SD] age, 39.6 [12.1] years; 533 male [63.2%]), 158 (18.7%) died of natural causes during a median follow-up of 14.4 years (range, 7.0 days to 23.9 years). The most significant factor associated with mortality was lower cognitive functioning as measured by the RBANS (Cox coefficient, -0.04; 95% CI, -0.05 to -0.03; z = -5.72; adjusted P < .001). Additional factors independently associated with mortality included the diagnosis of an autoimmune disorder (hazard ratio [HR], 2.86; 95% CI, 1.83-4.47; z = 4.62; adjusted P < .001), tobacco smoking (HR, 2.26; 95% CI, 1.55-3.30; z = 4.23; adjusted P < .001), diagnosis of chronic obstructive pulmonary disease (HR, 3.31; 95% CI, 1.69-6.49; z = 3.48; adjusted P = .006), body mass index as a continuous variable (HR, 1.06; 95% CI, 1.02-1.09; z = 3.30; adjusted P = .01), diagnosis of a cardiac rhythm disorder (HR, 2.56; 95% CI, 1.40-4.69; z = 3.06; adjusted P = .02), and being divorced or separated (HR, 1.80; 95% CI, 1.22-2.65; z = 2.97; adjusted P = .02). An RBANS score below the 50th percentile displayed a joint association with being a smoker, having an elevated body mass index, and having a diagnosis of an autoimmune or a cardiac rhythm disorder.
UNASSIGNED: In this prospective cohort study, lower cognitive functioning was a risk factor for natural cause mortality in schizophrenia. Efforts should be directed at methods to improve cognitive functioning, particularly among individuals with additional risk factors.