de las Cuevas C, Sanz E J, de la Fuente J A, Cueto M
Departamento de Psiquiatría, Universidad de La Laguna, Tenerife.
Actas Esp Psiquiatr. 2005 Mar-Apr;33(2):81-6.
Polypharmacy with psychoactive drugs is an increasingly common and debatable contemporary practice in clinical psychiatry more probably based on experience than evidence. The objective of this study was to evaluate the prevalence and estimators of polypharmacy in psychiatric patients living in an area with very limited mental health resources.
All patients (n = 352) with mental disorders receiving psychotropic medication living in La Gomera were studied through an audit of case records and a second phase confirmation strategy through personal interviews.
The mean number of psychoactive drugs prescribed was 2.22 +/- 0.70 (range: 1-6). The rate of polypharmacy was 67 %, with 34.1 % of patients receiving two drugs, 20.5 % receiving three drugs and 12.5 % of the patients receiving four or more psychotropic drugs at the same time. Multiple regression analysis shows that none of the variables considered (age, sex, marital status, educational level, work activity and diagnosis) had predictive value in regards to the number of psychotropic drug used. Benzodiazepines were the most prevalent drugs in single drug therapy, while antidepressants and antipsychotics were the most used in combination with other treatment. A questionably very high degree of same-class polypharmacy was observed, while multiclass, adjunctive and augmentation polypharmacy seems to be more appropriate.
The psychiatric clinical practice needs to develop indicators for an appropriate polypharmacy of mental disorders. More research is still needed to identify patients at risk of polypharmacy in order to develop interventions that minimize the risks associated to this treatment alternative.
使用精神活性药物的联合用药在临床精神病学中是一种日益常见且存在争议的当代做法，其更多基于经验而非证据。本研究的目的是评估生活在心理健康资源非常有限地区的精神科患者联合用药的患病率及评估指标。
通过审查病例记录对所有居住在拉戈梅拉岛且正在接受精神药物治疗的精神障碍患者（n = 352）进行研究，并通过个人访谈进行第二阶段确认策略。
所开具精神活性药物的平均数量为2.22±0.70（范围：1 - 6）。联合用药率为67%，其中34.1%的患者服用两种药物，20.5%的患者服用三种药物，12.5%的患者同时服用四种或更多精神药物。多元回归分析表明，所考虑的变量（年龄、性别、婚姻状况、教育水平、工作活动和诊断）在精神药物使用数量方面均无预测价值。苯二氮䓬类药物在单一药物治疗中最为常见，而抗抑郁药和抗精神病药在与其他治疗联合使用时最为常用。观察到一种可疑的非常高程度的同类联合用药情况，而多类、辅助和增效联合用药似乎更为合适。
精神科临床实践需要制定精神障碍合理联合用药的指标。仍需要更多研究来识别联合用药风险患者，以便制定干预措施，将与这种治疗选择相关的风险降至最低。
