Magliano Lorenza, Fiorillo Andrea, Guarneri Manuela, Marasco Cecilia, De Rosa Corrado, Malangone Claudio, Maj Mario
Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
Eur J Clin Pharmacol. 2004 Sep;60(7):513-22. doi: 10.1007/s00228-004-0803-7.
This study aims to: (a) describe the type and doses of psychotropic drugs received by outpatients with schizophrenia in Italy; (b) explore the relationship between prescription and patients' clinical conditions, disability and socio-demographic characteristics; and (c) estimate the percentage of patients receiving polypharmacy and antipsychotics within the official recommended ranges.
A total of 682 patients with schizophrenia were consecutively recruited in 30 Italian mental health departments, randomly selected taking into account the geographic location and population density of their catchment areas.
Of the sample, 98% were in treatment with neuroleptics, 47% received benzodiazepines, 25% were on anticholinergics, 10% were prescribed antidepressants and 8% were on mood stabilisers. Polypharmacy was found in 29% of the sample. Patients treated with one neuroleptic received this within therapeutic doses in 77% of cases. In patients who received two neuroleptics (24%), the former was prescribed within the official range in 71% of cases and the latter in 46%. Polytherapy was more frequently prescribed in patients treated with typicals (60% versus 34%) and in those who also received benzodiazepines (61% versus 41%) and anticholinergics (44% versus 16%). Patients in treatment with atypicals (45%) were mainly younger and lived in highly populated areas. Depot medications (25%) were more frequently prescribed to patients living in areas of low population density, who were older and who had a lower educational level, a longer duration of illness and milder anxiety/depression symptoms.
The consistent percentage of patients receiving polypharmacy and neuroleptics outside the therapeutic doses highlights the need to promote interventions aimed at increasing a rational use of psychotropic drugs among mental health professionals.
本研究旨在：（a）描述意大利精神分裂症门诊患者所接受的精神药物类型和剂量；（b）探讨处方与患者临床状况、残疾情况及社会人口学特征之间的关系；（c）估算接受联合用药以及接受处于官方推荐范围内的抗精神病药物治疗的患者百分比。
在意大利30个精神卫生部门连续招募了总共682例精神分裂症患者，根据其服务区域的地理位置和人口密度进行随机选择。
在样本中，98%的患者接受抗精神病药物治疗，47%的患者接受苯二氮䓬类药物治疗，25%的患者使用抗胆碱能药物，10%的患者开具了抗抑郁药，8%的患者使用心境稳定剂。29%的样本存在联合用药情况。接受一种抗精神病药物治疗的患者中，77%的病例使用剂量处于治疗剂量范围内。在接受两种抗精神病药物治疗的患者（24%）中，前者71%的病例处方剂量处于官方推荐范围内，后者为46%。接受传统抗精神病药物治疗的患者（60%）和同时接受苯二氮䓬类药物（61%）及抗胆碱能药物（44%）治疗的患者比接受非传统抗精神病药物治疗的患者（34%和16%）更常采用联合治疗。接受非传统抗精神病药物治疗的患者（45%）主要年龄较轻，居住在人口密集地区。长效药物（25%）更常被开给居住在人口密度低的地区、年龄较大、教育程度较低、病程较长且焦虑/抑郁症状较轻的患者。
接受联合用药以及接受超出治疗剂量的抗精神病药物治疗的患者比例较高，这凸显了需要推动旨在促进精神卫生专业人员合理使用精神药物的干预措施。
