摘要

BACKGROUND:Although selective serotonin reuptake inhibitors (SSRIs) are widely prescribed, associations with violence are uncertain. METHODS AND FINDINGS:From Swedish national registers we extracted information on 856,493 individuals who were prescribed SSRIs, and subsequent violent crimes during 2006 through 2009. We used stratified Cox regression analyses to compare the rate of violent crime while individuals were prescribed these medications with the rate in the same individuals while not receiving medication. Adjustments were made for other psychotropic medications. Information on all medications was extracted from the Swedish Prescribed Drug Register, with complete national data on all dispensed medications. Information on violent crime convictions was extracted from the Swedish national crime register. Using within-individual models, there was an overall association between SSRIs and violent crime convictions (hazard ratio [HR] = 1.19, 95% CI 1.08-1.32, p < 0.001, absolute risk = 1.0%). With age stratification, there was a significant association between SSRIs and violent crime convictions for individuals aged 15 to 24 y (HR = 1.43, 95% CI 1.19-1.73, p < 0.001, absolute risk = 3.0%). However, there were no significant associations in those aged 25-34 y (HR = 1.20, 95% CI 0.95-1.52, p = 0.125, absolute risk = 1.6%), in those aged 35-44 y (HR = 1.06, 95% CI 0.83-1.35, p = 0.666, absolute risk = 1.2%), or in those aged 45 y or older (HR = 1.07, 95% CI 0.84-1.35, p = 0.594, absolute risk = 0.3%). Associations in those aged 15 to 24 y were also found for violent crime arrests with preliminary investigations (HR = 1.28, 95% CI 1.16-1.41, p < 0.001), non-violent crime convictions (HR = 1.22, 95% CI 1.10-1.34, p < 0.001), non-violent crime arrests (HR = 1.13, 95% CI 1.07-1.20, p < 0.001), non-fatal injuries from accidents (HR = 1.29, 95% CI 1.22-1.36, p < 0.001), and emergency inpatient or outpatient treatment for alcohol intoxication or misuse (HR = 1.98, 95% CI 1.76-2.21, p < 0.001). With age and sex stratification, there was a significant association between SSRIs and violent crime convictions for males aged 15 to 24 y (HR = 1.40, 95% CI 1.13-1.73, p = 0.002) and females aged 15 to 24 y (HR = 1.75, 95% CI 1.08-2.84, p = 0.023). However, there were no significant associations in those aged 25 y or older. One important limitation is that we were unable to fully account for time-varying factors. CONCLUSIONS:The association between SSRIs and violent crime convictions and violent crime arrests varied by age group. The increased risk we found in young people needs validation in other studies.

译文

背景: 尽管选择性 5-羟色胺再摄取抑制剂 (SSRIs) 被广泛使用,但与暴力的关联仍不确定。方法和发现: 从瑞典国家登记册中,我们提取了 856,493 名被开了 SSRIs 的个人的信息,以及 2006年至 2009年期间的后续暴力犯罪。我们使用分层 Cox 回归分析来比较个体服用这些药物时的暴力犯罪率与同一个体不接受药物时的暴力犯罪率。对其他精神药物进行了调整。关于所有药物的信息都是从瑞典处方药登记册中提取的,包括所有分发药物的完整国家数据。关于暴力犯罪定罪的信息是从瑞典国家犯罪登记册中提取的。使用个体内模型,SSRIs 和暴力犯罪定罪之间存在整体关联 (风险比 [HR] = 1.19,95% CI 1.08-1.32,p <0.001, 绝对风险 = 1.0%)。随着年龄的分层,在 15 到 24 岁的个体中,选择性血清素再吸收抑制剂和暴力犯罪定罪之间存在显著的关联 (HR = 1.43,95% CI 1.19-1.73,p <0.001, 绝对风险 = 3.0%)。然而,在 25-34 岁的人群中没有显著的关联 (HR = 1.20,95% CI 0.95-1.52,p = 0.125,绝对风险 = 1.6%), 在 35-44 岁的人群中 (HR = 1.06,95% CI 0.83-1.35,p = 0.666,绝对风险 = 1.2%),或者在 45 岁或以上的人群中 (HR = 1.07,95% CI 0.84-1.35,p = 0.594,绝对风险 = 0.3%)。在那些年龄在 15 到 24 岁的人群中,初步调查也发现了暴力犯罪逮捕的关联 (HR = 1.28,95% CI 1.16-1.41,p <0.001), 非暴力犯罪定罪 (HR = 1.22,95% CI 1.10-1.34,p <0.001),非暴力犯罪逮捕 (HR = 1.13,95% CI 1.07-1.20,P <0.001),事故造成的非致命性伤害 (HR = 1.29,95% CI 1.22-1.36,p <0.001), 和酒精中毒或误用的急诊住院或门诊治疗 (HR = 1.98,95% CI 1.76-2.21,p & lt; 0.001)。随着年龄和性别分层,15 至 24 岁男性的选择性血清素再吸收抑制剂和暴力犯罪定罪之间存在显著关联 (HR = 1.40,95% CI 1.13-1.73,p = 0.002) 和 15 至 24 岁的女性 (HR = 1.75,95% CI 1.08-2.84,p = 0.023)。然而,在 25 岁或以上的人群中没有显著的关联。一个重要的限制是我们不能完全解释时变因素。结论: SSRIs 与暴力犯罪定罪和暴力犯罪逮捕之间的联系因年龄组而异。我们在年轻人身上发现的增加的风险需要在其他研究中得到验证。

Selective Serotonin Reuptake Inhibitors

神经 抑制剂 治疗药物
概述  :  

5-羟色胺再摄取抑制剂的治疗作用是由于它们能够抑制突触前5-羟色胺能神经末梢对5-羟色胺的再摄取。主要有氟西汀、帕罗西汀、舍曲林、氟伏沙明、西酞普兰、艾司西酞普兰。不同SSRIs之间存在着很大差异。药物对其他神经递质系统也有作用,不同SSRIs对不同递质受体的亲和性、不同递质再摄取的抑制程度不同。氟西汀是一种强效选择性5-HT摄取抑制剂,比抑制NA摄取作用强200倍。氟西汀对肾上腺素受体、组胺受体、GABAβ受体、M受体、5-HT受体几乎亲和力。对抑郁症的疗效与TCAs相当。此外该药对强迫症

selective   英 [sɪˈlektɪv]  美 [sɪˈlektɪv] 

释    义   adj. 选择性的;讲究的;有选择地;有选择性地;仔细挑选地

例    句   Be selective about how you use your time and what you focus on. 有选择性地使用你的时间和专注你需要的事物。

 

serotonin   英 [ˌserəˈtəʊnɪn]  美 [ˌserəˈtoʊnɪn] 

释    义   n. 血清素;5-羟色胺(血管收缩素)

例    句   Some people had two "long" versions of the promoter gene (one inherited from each parent), acombination that reduces the amount of serotonin in the junctions between nerve cells. 有些人具有两个“长”版本的启动子基因(遗传自双亲),这种组合减少了神经细胞节中血清素的含量。

 

reuptake   [ri'ʌp,tek] 

释    义   v. 再摄取;再吸收

例    句   Large trials of selective serotonin reuptake inhibitors are being carried out in order to assess their effectiveness in reducing the above symptoms. 进行血液中特定复合胺再摄取抑制剂的大量实验从而评估对以上症状的减轻是否有效。

 

inhibitors

释    义   n. [助剂] 抑制剂;禁制因素,[化学] 抑制因子;阻止剂(inhibitor的复数)

例    句   If these would demonstrate that then there would be an even stronger rationale to use rennin inhibitors alone or in combination. 如果这一点得到证实的话,那么我们就会更有理由在单独用药和联合治疗中使用肾素抑制剂了。

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