嚴重精神病人的死因研究：文獻回顧

預防醫學的課題之一是瞭解死亡原因，而釐清死亡原因則是法醫學的使命。作為醫學的重要部門之一的精神醫學，透過死亡原因的瞭解，可以預防過早死亡的發生，從而提升醫療品質。精神科的個案並不常發生醫療爭議，但是醫療爭議通常是牽涉到醫療照護的品質、醫療法規的遵守與否，或是否符合醫療倫理的原則。透過健保資料庫與衛生福利部死亡檔的數據分析，台灣對於精神疾病的死亡原因，已有許多實證文獻，發表於國內外醫學期刊。精神病人的非自然死因主要是自殺，自然死因主要是心因性猝死，包括心臟血管疾病；我國的研究發現，抗精神病藥物導致的肺炎則常常被忽略。本文回顧文獻，探討精神病人的自然與非自然的死亡原因，建構精神醫學與法醫學的橋樑，旨在提升醫療品質，提供法醫鑑定的參考。

關鍵字

非自然死因；思覺失調症；自殺；心因性猝死；肺炎

並列摘要

The preventive medicine and the forensic medicine share the major mission to figure out the causes of death which bears the role of health promotion and social justice. As one of the branches of medicine, it is the obligation for the psychiatry to share the responsibility to explore the causes of death of severe mental disorders, such as schizophrenia and mood disorders in order to prevent premature death. The main cause of un-natural death of severe mental disorders is suicide. While the main cause of nature death is sudden cardiac death, the risk of pneumonia is frequently neglected. The purpose of this article is to review the research in Taiwan which may bridge between the forensic medicine and psychiatry and to promote quality of health care.

並列關鍵字

Un-Natural Death ； Schizophrenia ； Suicide ； Cardiac Death ； Pneumonia

參考文獻

Tsai SY, Lee CH, Kuo CJ, Chen CC: A retrospective analysis of risk and protective factors for natural death in bipolar disorder. J Clin Psychiatry 2005;66:1586-91. doi:10.4088/jcp.v66n1215

Chen PH, Tsai SY, Pan CH, et al.: Age effect of antipsychotic medications on the risk of sudden cardiac death in patients with schizophrenia: a nationwide case-crossover study. Psychiatry Clin Neurosci 2020;74:594-601. doi:10.1111/pcn.13116

Tsai SY, Kuo CJ, Chen CC, Lee HC: Risk factors for completed suicide in bipolar disorder. J Clin Psychiatry 2002;63:469-76. doi:10.4088/jcp.v63n0602

Kuo CJ, Tsai SY, Lo CH, Wang YP, Chen CC: Risk factors for completed suicide in schizophrenia. J Clin Psychiatry 2005;66:579-85. doi:10.4088/jcp.v66n0506

Chen CH, Chiu CC, Huang MC, Wu TH, Liu HC, Lu ML: Metformin for metabolic dysregulation in schizophrenic patients treated with olanzapine. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:925-31. doi:10.1016/j.pnpbp.2007.11.013

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