Sørensen L, Foldspang A, Gulmann N C, Munk-Jørgensen P
Department of Psychiatric Demography, Psychiatric Hospital in Aarhus, Aarhus University Hospital, Skovagervej 2, DK-8240 Risskov, Denmark.
Int J Geriatr Psychiatry. 2001 Feb;16(2):147-54. doi: 10.1002/1099-1166(200102)16:2<147::aid-gps286>3.0.co;2-4.
To characterise the prescription pattern of psychotropics in Danish nursing homes and to identify diagnostic, behavioural, cognitive and performance characteristics associated with prevalent psychotropic drug use.
Prescribed daily medication was recorded from nurses' files. Based on the Anatomical Therapeutical Chemical (ATC) classification index, psychotropics were categorised into neuroleptics, benzodiazepines and antidepressants. Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. One hundred and eighteen staff members were interviewed about the residents's Activities of Daily Living (ADL), behavioural problems (Nursing Home Behavior Problem Scale), orientation, communication skills and if the resident had any psychiatric disorder. Multiple logistic regression was used to select the items that determined the use of psychotropics.
Fifty-six percent of the residents received a psychotropic, 21% received neuroleptics, 38% received benzodiazepines and 24% received antidepressants. In the multivariate analysis, staff assessment of the resident's mental health was a determinant for the use of all types of specific psychotropics, whereas a GMS-AGECAT diagnosis only determined the use of neuroleptics. Behavioural problems were a determinant for the use of neuroleptics and the use of benzodiazepines irrespective of the psychiatric diagnosis of the resident. Use of antidepressants was associated with male gender and increasing age.
Staff perceptions of psychiatric morbidity and norms have a greater impact on the prescription of psychotropics than standardised clinical criteria.
描述丹麦养老院中精神药物的处方模式，并确定与普遍使用精神药物相关的诊断、行为、认知和功能特征。
从护士档案中记录每日处方药物。根据解剖治疗化学（ATC）分类索引，将精神药物分为抗精神病药、苯二氮䓬类药物和抗抑郁药。使用GMS-AGECAT对288名居民进行诊断。就居民的日常生活活动（ADL）、行为问题（养老院行为问题量表）、定向、沟通能力以及居民是否患有任何精神疾病，对118名工作人员进行了访谈。采用多元逻辑回归来选择决定精神药物使用的项目。
56%的居民接受了精神药物治疗，21%接受了抗精神病药，38%接受了苯二氮䓬类药物，24%接受了抗抑郁药。在多变量分析中，工作人员对居民心理健康的评估是所有类型特定精神药物使用的决定因素，而GMS-AGECAT诊断仅决定抗精神病药的使用。行为问题是抗精神病药和苯二氮䓬类药物使用的决定因素，与居民的精神诊断无关。抗抑郁药的使用与男性性别和年龄增长有关。
工作人员对精神疾病发病率和规范的认知对精神药物处方的影响大于标准化临床标准。
