Centorrino Franca, Ventriglio Antonio, Vincenti Alessio, Talamo Alessandra, Baldessarini Ross J
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Hum Psychopharmacol. 2010 Mar;25(2):179-86. doi: 10.1002/hup.1095.
We tested the hypothesis that combinations and total daily doses of psychotropics for hospitalized patients diagnosed with major psychiatric disorders are rising.
We evaluated McLean Hospital records of 481 consecutive inpatients with DSM-IV schizophrenia, schizoaffective, or bipolar disorders in 2004 (n = 278) or 2009 (n = 203) to compare characteristics and treatments.
In 2009, Clinical Global Impression (CGI)-severity scores were 6% lower at intake and improved 1.7 times more than in 2004, as hospitalization-length decreased by 12%. Polytherapy (> or = 2 psychotropics) increased in 2009 (affective or schizoaffective disorders > schizophrenia). Total psychotropics/patient (3.1-3.2) remained stable but mood-stabilizers/patient increased markedly and antipsychotics/patient decreased somewhat in 2009. Antipsychotic-choice (2009) ranked: quetiapine, aripiprazole, risperidone, and others; mood-stabilizers ranked: lamotrigine, valproate, lithium, and others (1/4 off-label). In 2009, final total antipsychotic doses (mg/day) increased by 97%, and mood-stabilizers by 75%. Adverse-effect rates fell by half. Factors differing independently for 2009 versus 2004 ranked: (a) more CGI improvement, (b) more mood-stabilizers/patient, (c) lower admission CGI scores, and (c) higher total antipsychotic dose.
Combinations and doses of antipsychotic and mood-stabilizing drugs for inpatients increased markedly (2004 vs. 2009) without consistent correspondence of agents/person and doses, without apparent increase in major adverse effects, and with possibly superior clinical improvement.
我们检验了这样一个假设，即被诊断患有重度精神疾病的住院患者使用的精神药物的组合及每日总剂量正在增加。
我们评估了麦克莱恩医院2004年（n = 278）或2009年（n = 203）连续收治的481例诊断为DSM-IV精神分裂症、分裂情感性障碍或双相情感障碍的住院患者的记录，以比较其特征和治疗情况。
2009年，临床总体印象（CGI）严重程度评分在入院时降低了6%，改善程度是2004年的1.7倍，住院时间减少了12%。联合治疗（使用≥2种精神药物）在2009年有所增加（情感性或分裂情感性障碍患者比精神分裂症患者增加得更多）。每位患者使用的精神药物总数（3.1 - 3.2种）保持稳定，但2009年每位患者使用的心境稳定剂显著增加，而每位患者使用的抗精神病药物有所减少。2009年抗精神病药物的选择顺序为：喹硫平、阿立哌唑、利培酮及其他；心境稳定剂的顺序为：拉莫三嗪、丙戊酸盐、锂盐及其他（四分之一为非适应证用药）。2009年，抗精神病药物的最终每日总剂量（毫克/天）增加了97%，心境稳定剂增加了75%。不良反应发生率下降了一半。2009年与2004年相比，独立存在差异的因素依次为：（a）CGI改善更明显；（b）每位患者使用的心境稳定剂更多；（c）入院时CGI评分更低；（d）抗精神病药物总剂量更高。
2004年至2009年期间，住院患者使用的抗精神病药物和心境稳定剂的组合及剂量显著增加，药物种类/人数与剂量之间没有一致的对应关系，主要不良反应没有明显增加，且临床改善情况可能更好。
