精神分裂症患者锥体外系症状管理中的全国处方模式。

National prescribing patterns in the management of extrapyramidal symptoms among patients with schizophrenia.

作者信息

Luo Roger D, Belleti Daniel A, Tran Dung, Arcona Stephen, Salen Philip N

机构信息

PE Consulting, Lake Hiawatha, New Jersey, USA.

出版信息

Int J Psychiatry Med. 2002;32(3):261-9. doi: 10.2190/3XN7-3E6A-9XMG-U91C.

DOI:10.2190/3XN7-3E6A-9XMG-U91C

PMID:12489701

Abstract

PURPOSE

Antipsychotics, particularly typical agents, have been shown to cause extrapyramidal symptoms (EPS). We hypothesized a negative association between concomitant (at same visit) prescriptions for atypical antipsychotics and prescriptions for medications to manage EPS.

METHOD

We combined National Ambulatory Medical Care Survey (NAMCS) data from 1993 through 1999 for visits by patients with a diagnosis of schizophrenia (ICD-9 295.0-295.9), that included a prescription for either an atypical or typical antipsychotic (but not both). We also constructed two, scale-weighted logistic regression models to separately estimate the odds and probabilities of receiving prescriptions for an antipsychotic and for a medication used to treat EPS.

RESULTS

From 1993 through 1999, there were an estimated 10,475,507 office visits with schizophrenia as a diagnosis; 7,371,625 (70.4 percent) included a prescription for a conventional (typical) antipsychotic. Thirty-four percent of visits included a prescription for a medication used to treat EPS. Being in the older age group, having Medicaid as primary coverage, belonging to an HMO, and being female significantly reduced the probability of receiving an atypical antipsychotic by 12.6 percent, 10.9 percent, 15.1 percent and 10.2 percent, respectively. Caucasian patients were 14 percent more likely to be prescribed an atypical. Antipsychotic type had a clinically and statistically significant effect on EPS management prescribing. A prescription for an atypical antipsychotic reduced the probability of receiving a concomitant prescription for EPS management by 26.8 percent.

CONCLUSION

As expected, we observed the hypothesized joint prescribing pattern. The results ofthis study suggest that atypical antipsychotic prescriptions strongly predict fewer prescriptions for EPS treatment, and, by implication, reduced need for EPS treatment in actual ambulatory care practices throughout the nation.

摘要

目的

抗精神病药物，尤其是传统药物，已被证明会引起锥体外系症状（EPS）。我们推测非典型抗精神病药物的同期（同一次就诊时）处方与用于治疗EPS的药物处方之间存在负相关。

方法

我们合并了1993年至1999年全国门诊医疗护理调查（NAMCS）中诊断为精神分裂症（国际疾病分类第九版295.0 - 295.9）患者就诊的数据，这些就诊包括非典型或传统抗精神病药物的处方（但不同时开具两者）。我们还构建了两个加权逻辑回归模型，分别估计开具抗精神病药物处方和用于治疗EPS的药物处方的几率和概率。

结果

1993年至1999年期间，估计有10475507次门诊诊断为精神分裂症；7371625次（70.4%）包括传统（典型）抗精神病药物的处方。34%的就诊包括用于治疗EPS的药物处方。年龄较大、以医疗补助作为主要医保、属于健康维护组织（HMO）以及女性显著降低了开具非典型抗精神病药物处方的概率，分别降低了12.6%、10.9%、15.1%和10.2%。白人患者开具非典型药物处方的可能性高14%。抗精神病药物类型对EPS治疗处方有临床和统计学上的显著影响。非典型抗精神病药物处方使同期开具EPS治疗处方的概率降低了26.8%。