Chakrabarti A, Whicher E, Morrison M, Douglas-Hall P
Malham House, Hyde Terrace, Leeds, UK.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD003441. doi: 10.1002/14651858.CD003441.pub2.
Drugs used to treat psychotic illnesses may take weeks to be effective. In the interim, additional 'as required' doses of medication can be used to calm patients in psychiatric wards. The practice is widespread with 20% - 50% of people on acute psychiatric wards receiving at least one 'as required' dose of psychotropic medication during their admission.
To compare the effects of 'as required' medication regimens with regular regimens of medication for the treatment of psychotic symptoms or behavioural disturbance, thought to be secondary to psychotic illness.
For this 2006 update, we searched The Cochrane Schizophrenia Group's register of trials (March 2006).
We included all relevant randomised control trials involving hospital inpatients with schizophrenia or schizophrenia-like illnesses, comparing any regimen of medication administered for the short term relief of behavioural disturbance, or psychotic symptoms, to be given at the discretion of ward staff ('as required', 'prn') with fixed non-discretionary patterns of drug administration of the same drug(s). This was in addition to regular psychotropic medication for the long-term treatment of schizophrenia or schizophrenia-like illnesses where prescribed.
We independently inspected abstracts, extracted data from the papers and quality assessed the data. For dichotomous data we would have calculated the relative risks (RR), with the 95% confidence intervals (CI) and the number needed to treat statistic (NNT). Analyses would have been conducted on an intention-to-treat basis.
We didn't identify any randomised trials comparing 'as required' medication regimens to regular regimens of the same drug.
AUTHORS' CONCLUSIONS: There is no evidence from within randomised trials to support this common current practices. Current practice is based on clinical experience and habit rather than high quality evidence.
用于治疗精神疾病的药物可能需要数周时间才能起效。在此期间，可以使用额外的“按需”剂量药物来使精神科病房中的患者平静下来。这种做法很普遍，20% - 50%的急性精神科病房患者在住院期间至少接受一剂“按需”精神药物治疗。
比较“按需”用药方案与常规用药方案对治疗被认为继发于精神疾病的精神症状或行为障碍的效果。
对于2006年的更新，我们检索了Cochrane精神分裂症研究组的试验注册库（2006年3月）。
我们纳入了所有相关的随机对照试验，这些试验涉及患有精神分裂症或类精神分裂症疾病的住院患者，比较了由病房工作人员酌情给予（“按需”，“必要时”）用于短期缓解行为障碍或精神症状的任何用药方案，与相同药物的固定非酌情给药模式。这是除了用于精神分裂症或类精神分裂症疾病长期治疗的常规精神药物（如已开具）之外的情况。
我们独立检查摘要，从论文中提取数据并对数据进行质量评估。对于二分数据，我们本应计算相对风险（RR）、95%置信区间（CI）和治疗所需人数统计量（NNT）。分析将基于意向性治疗进行。
我们未找到任何将“按需”用药方案与相同药物的常规方案进行比较的随机试验。
随机试验中没有证据支持这种当前常见的做法。当前的做法基于临床经验和习惯，而非高质量证据。
