Kreyenbuhl Julie, Valenstein Marcia, McCarthy John F, Ganoczy Dara, Blow Frederic C
Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Schizophr Res. 2006 May;84(1):90-9. doi: 10.1016/j.schres.2006.02.023. Epub 2006 May 2.
Treatment guidelines consider antipsychotic monotherapy the standard of care for patients with schizophrenia. However, previous studies have reported widely varying, and sometimes high, rates of antipsychotic polypharmacy. We identified 61,257 VA patients with schizophrenia in fiscal year 2000 who had >or=90 non-institutionalized days and one or more fills of antipsychotic medications. We used criteria of increasing stringency (>or=30, >or=60, or >or=90 overlapping days' supply of antipsychotic medications) and several cross-sectional criteria from previous studies to compare the prevalence of antipsychotic polypharmacy using these definitions. We also describe specific treatment combinations among patients receiving long-term polypharmacy. The prevalence of antipsychotic polypharmacy was 20.0%, 13.1%, and 9.5% when defined by a >or=30, >or=60, or >or=90-day overlap, respectively. Cross-sectional definitions used in previous studies did not identify 32-89% of patients receiving long-term polypharmacy (>or=90 days). In addition, approximately half of patients identified by cross-sectional criteria had only short-term overlaps of antipsychotic medications. Among patients receiving long-term polypharmacy, 74% received a first- and a second-generation agent, 18% received two second-generation agents, and 6% received two first-generation agents. Definitions of polypharmacy that rely on cross-sectional data or narrow observation periods do not accurately identify patients receiving long-term treatment; in this study, only 10% of patients with schizophrenia received combination treatments for >or=90 days. The most commonly used antipsychotic combinations have little support for safety or efficacy. Further research is needed to understand the impact of these treatments on symptoms, side effects, and costs.
治疗指南将抗精神病药物单一疗法视为精神分裂症患者的标准治疗方案。然而，以往研究报告的抗精神病药物联合使用比例差异很大，有时甚至很高。我们确定了2000财年61257名患有精神分裂症的退伍军人事务部（VA）患者，这些患者非住院天数≥90天且有一次或多次抗精神病药物配药记录。我们使用了越来越严格的标准（抗精神病药物供应重叠天数≥30天、≥60天或≥90天）以及以往研究中的几个横断面标准，来比较使用这些定义的抗精神病药物联合使用的患病率。我们还描述了接受长期联合用药患者的具体治疗组合。当定义为重叠天数≥30天、≥60天或≥90天时，抗精神病药物联合使用的患病率分别为20.0%、13.1%和9.5%。以往研究中使用的横断面定义未识别出32%-89%接受长期联合用药（≥90天）的患者。此外，通过横断面标准识别出的患者中，约一半只有抗精神病药物的短期重叠使用情况。在接受长期联合用药的患者中，74%同时使用了第一代和第二代药物，18%使用了两种第二代药物，6%使用了两种第一代药物。依赖横断面数据或狭窄观察期的联合用药定义不能准确识别接受长期治疗的患者；在本研究中，只有10%的精神分裂症患者接受了≥90天的联合治疗。最常用的抗精神病药物组合在安全性或疗效方面几乎没有依据。需要进一步研究以了解这些治疗对症状、副作用和成本的影响。
