Lerma-Carrillo Ivan, de Pablo Brühlmann Silvia, del Pozo Marta Leonor, Pascual-Pinazo Fernando, Molina Juan D, Baca-García Enrique
Acute Inpatients Unit, Dr. R. Lafora Psychiatric Hospital, Madrid, Spain.
Clin Neuropharmacol. 2008 Nov-Dec;31(6):319-32. doi: 10.1097/WNF.0b013e31815cba78.
Antipsychotic monotherapy is considered the gold standard in pharmacological treatment of schizophrenia and other psychotic disorders. Only 2 of the main clinical guides recommend the use of antipsychotic polypharmacy (AP) for those patients refractory to monotherapy. Nonetheless, there is a large rate of studies, conducted in many different settings, showing that AP is more frequent as would be expected attending experts' recommendations.
In this retrospective study, we review all the psychotropic drugs dispensed to inpatients of a brief hospitalization psychiatric unit diagnosed as having schizophrenia or schizoaffective disorder (International Statistical Classification of Diseases, 10th Revision) at time of discharge in the year 2005. These included a total of 209 patients older than 18 years.
Of the 209 studied patients, 55.5% were discharged under AP treatment. Inpatients were given a mean of 3.06 psychotropic drugs and a mean of 1.61 antipsychotics at the time of hospital discharge. A total of 33.2% of the studied patients got anticholinergic drugs, and 66.2% were given benzodiazepines. The most prevalent combination of drugs was intramuscular long-acting risperidone plus an atypical antipsychotic. Amisulpride was the most used antipsychotic as adjuvant treatment.
Despite different clinical guidelines, AP is a common pharmacological strategy as it is shown in our study and in the reviewed literature. Data in our study indicate that the observed rates of AP cannot exclusively be attributed to the treatment of patients with clozapine-resistant schizophrenia.
抗精神病药物单一疗法被认为是精神分裂症和其他精神障碍药物治疗的金标准。只有两份主要临床指南推荐对单一疗法难治的患者使用抗精神病药物联合治疗（AP）。尽管如此，在许多不同环境下进行的大量研究表明，AP的使用比专家建议的预期更为频繁。
在这项回顾性研究中，我们回顾了2005年出院时被诊断患有精神分裂症或分裂情感性障碍（国际疾病分类第10版）的短期住院精神科病房住院患者所使用的所有精神药物。这些患者共有209名，年龄均超过18岁。
在209名研究患者中，55.5%在出院时接受AP治疗。住院患者出院时平均使用3.06种精神药物和1.61种抗精神病药物。共有33.2%的研究患者使用了抗胆碱能药物，66.2%的患者使用了苯二氮䓬类药物。最常见的药物组合是肌肉注射长效利培酮加一种非典型抗精神病药物。氨磺必利是最常用的作为辅助治疗的抗精神病药物。
尽管有不同的临床指南，但正如我们的研究和所回顾的文献所示，AP是一种常见的药物治疗策略。我们研究中的数据表明，观察到的AP使用率不能完全归因于对氯氮平难治性精神分裂症患者的治疗。
