Barbui Corrado, Biancosino Bruno, Esposito Eleonora, Marmai Luciana, Donà Silvia, Grassi Luigi
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Verona, Italy.
Int Clin Psychopharmacol. 2007 Jul;22(4):221-5. doi: 10.1097/YIC.0b013e3281084ea8.
The persistent use of doses in excess of recommended levels is associated with increased risks of adverse reactions without evidence of additional benefits. Such treatment modality was evaluated in hospitalized psychiatric patients. During a 6-year recruitment period, a consecutive series of psychiatric inpatients receiving antipsychotic therapy were included. At admission, sociodemographic and clinical data, including antipsychotic drug use, were collected, and the 18-item version of the Brief Psychiatric Rating Scale was administered. At discharge, data on antipsychotic drug therapy were collected. Prescribed daily doses were converted into multiples of the defined daily doses. Using a cut-off score of a prescribed daily dose/defined daily dose as a ratio of more than 1.5 both at admission and at discharge assessments, a total of 62 (15.4%) patients persistently received high antipsychotic dose. With less stringent criteria (prescribed daily dose/defined daily dose as a ratio of more than 2), however, only 4.4% of the entire sample was persistently exposed to high antipsychotic doses. Bootstrapped linear regression analysis revealed that positive symptoms were positively associated with high antipsychotic dose, whereas negative symptoms were negatively associated with high antipsychotic dose. Antipsychotic polypharmacy at admission was the strongest predictor of persistently receiving antipsychotic doses in excess of recommended levels. This study showed that the use of high antipsychotic dosing is not an occasional event. Clinicians should consider that concurrent prescribing of two or more antipsychotic agents increases the probability of administering excessive dosing in the long-term.
持续使用超过推荐水平的剂量会增加不良反应风险，且无额外益处的证据。这种治疗方式在住院精神科患者中进行了评估。在6年的招募期内，纳入了一系列连续接受抗精神病治疗的精神科住院患者。入院时，收集社会人口学和临床数据，包括抗精神病药物使用情况，并使用18项版简明精神病评定量表进行评估。出院时，收集抗精神病药物治疗的数据。将规定的每日剂量换算为限定日剂量的倍数。以入院和出院评估时规定的每日剂量/限定日剂量的比值大于1.5作为临界值，共有62名（15.4%）患者持续接受高剂量抗精神病药物治疗。然而，采用较宽松的标准（规定的每日剂量/限定日剂量的比值大于2）时，整个样本中只有4.4%的患者持续暴露于高剂量抗精神病药物。自抽样线性回归分析显示，阳性症状与高剂量抗精神病药物呈正相关，而阴性症状与高剂量抗精神病药物呈负相关。入院时使用多种抗精神病药物是持续接受超过推荐水平抗精神病药物剂量最强的预测因素。这项研究表明，使用高剂量抗精神病药物并非偶然事件。临床医生应考虑，同时开具两种或更多种抗精神病药物会增加长期给予过量药物的可能性。
