Centorrino Franca, Fogarty Kate V, Sani Gabriele, Salvatore Paola, Cimbolli Paola, Baldessarini Ross J
Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, USA.
Hum Psychopharmacol. 2005 Jul;20(5):355-8. doi: 10.1002/hup.700.
Major changes in antipsychotic treatment in recent years encouraged a survey of inpatient practice in 2002, compared with earlier samples.
Based on records of a random sample of McLean Hospital inpatients prescribed antipsychotics in 2002, the study recorded DSM-IV discharge diagnosis, all psychotropic treatments and doses, initial, peak and final doses of all antipsychotics, clinical status at admission and discharge, and adverse effects reported. Results were compared with similar data from our earlier surveys.
Subjects were 344 inpatients (n = 202 women, 59%), diagnosed with psychotic (n = 102, 30%), bipolar (n = 93, 27%), major depressive (n = 67, 19.5%), dementia (n = 19, 5.5%), substance-use (n = 28, 8%) or other psychiatric disorders (n = 35, 10%). Second-generation antipsychotics accounted for 88% of antipsychotic prescriptions; 17% of patients received > or = 2 antipsychotics and total CPZ-eq discharge does in 2002 averaged 291 +/- 305 mg/day (22% less than a 1998 peak). Doses were unrelated to age, but higher in men, among psychotic vs major affective disorder patients, and with greater illness-severity and longer hospitalization. There was a 3.3-fold increase in the simultaneous use of > or = 3 psychotropic agents since 1998.
The use of second-generation antipsychotics dominates current inpatient practice. Total antipsychotic dosing has not increased recently, but the use of multiple psychotropics increased strikingly from 1998 to 2002.
近年来抗精神病药物治疗发生了重大变化，因此我们在2002年开展了一项针对住院患者治疗情况的调查，并与早期样本进行比较。
该研究基于2002年麦克莱恩医院开具抗精神病药物的住院患者随机样本记录，记录了《精神疾病诊断与统计手册》第四版（DSM-IV）出院诊断、所有精神药物治疗及剂量、所有抗精神病药物的初始剂量、峰值剂量和最终剂量、入院和出院时的临床状况以及报告的不良反应。研究结果与我们早期调查的类似数据进行了比较。
研究对象为344名住院患者（n = 202名女性，占59%），诊断患有精神病（n = 102，占30%）、双相情感障碍（n = 93，占27%）、重度抑郁症（n = 67，占19.5%）、痴呆（n = 19，占5.5%）、物质使用障碍（n = 28，占8%）或其他精神疾病（n = 35，占10%）。第二代抗精神病药物占抗精神病药物处方的88%；17%的患者接受了≥2种抗精神病药物治疗，2002年氯丙嗪等效总出院剂量平均为291±305毫克/天（比1998年的峰值低22%）。剂量与年龄无关，但男性、患有精神病的患者与患有重度情感障碍的患者相比、病情更严重以及住院时间更长的患者剂量更高。自1998年以来，同时使用≥3种精神药物的情况增加了3.3倍。
第二代抗精神病药物的使用在当前住院患者治疗中占主导地位。近期抗精神病药物的总剂量没有增加，但从1998年到2002年，多种精神药物的使用显著增加。
