Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
Ann Pharmacother. 2010 Jul-Aug;44(7-8):1171-80. doi: 10.1345/aph.1M643. Epub 2010 Jun 29.
Second-generation antipsychotics (SGAs) are thought to have a lower likelihood of inducing extrapyramidal symptoms (EPS) than are first-generation antipsychotics (FGAs). Clinical observations suggest that younger patients may be more sensitive to SGA-associated EPS than are adults and require therapy with anticholinergic agents.
To determine the proportion of patients 5-18 years of age who received anticholinergic therapy during the initial stages of antipsychotic treatment, as well as to compare anticholinergic utilization across patients receiving aripiprazole, risperidone, and quetiapine, SGAs previously identified as the most commonly prescribed at the academic institution studied.
Patients 5-18 years of age who were initiating a course of an antipsychotic between January 1, 2005, and September 1, 2008, were identified in a retrospective review of prescription and medical records. Data on demographic characteristics, antipsychotic and anticholinergic utilization, indications, diagnoses, and concomitant medications were collected from the medical record. Only the first therapeutic course of an antipsychotic identified was analyzed. Anticholinergic utilization at antipsychotic initiation and after 30 days was assessed.
A total of 235 antipsychotic treatment courses were identified. Of these, 152 patients met our inclusion criteria. Anticholinergic utilization at any time during the first 30 days of treatment was identified in 32 patients (21%), while EPS was documented for 12 patients (8%). FGA or polypharmacy (simultaneous use of >or=2 scheduled antipsychotic) use versus SGA use (OR 18.98; 95% CI 4.74 to 75.95) was the primary characteristic significantly associated with anticholinergic utilization within 30 days after initiation. Of the most commonly used SGAs, risperidone was the drug with which anticholinergics were most frequently prescribed (p = 0.03).
Anticholinergic prescribing exceeded the incidence of EPS, as documented in the medical record (21% vs 8%), and differed across individual medications and antipsychotic class. Utilization of FGAs or polypharmacy was a key predictor of anticholinergic use.
第二代抗精神病药物（SGAs）被认为比第一代抗精神病药物（FGAs）更不容易引起锥体外系症状（EPS）。临床观察表明，年轻患者可能比成年人更容易受到 SGA 相关 EPS 的影响，需要使用抗胆碱能药物进行治疗。
确定在抗精神病药物治疗的初始阶段，5-18 岁患者接受抗胆碱能治疗的比例，并比较接受阿立哌唑、利培酮和喹硫平治疗的患者的抗胆碱能药物利用情况，这些 SGA 是在研究的学术机构中最常被开处的药物。
通过回顾性审查处方和病历，确定了 2005 年 1 月 1 日至 2008 年 9 月 1 日期间开始服用抗精神病药物的 5-18 岁患者。从病历中收集人口统计学特征、抗精神病药物和抗胆碱能药物的使用情况、适应证、诊断和伴随用药的数据。仅分析第一次确定的抗精神病药物治疗过程。评估抗精神病药物起始时和 30 天后的抗胆碱能药物使用情况。
共确定了 235 个抗精神病药物治疗过程，其中 152 名患者符合我们的纳入标准。在治疗的前 30 天的任何时间，有 32 名患者（21%）使用了抗胆碱能药物，有 12 名患者（8%）记录了 EPS。与 SGA 相比，使用 FGA 或联合用药（同时使用≥2 种规定的抗精神病药物）的患者（OR 18.98；95%CI 4.74 至 75.95）是与 30 天内使用抗胆碱能药物显著相关的主要特征。在最常使用的 SGA 中，利培酮是最常开具抗胆碱能药物的药物（p=0.03）。
抗胆碱能药物的处方超过了病历中记录的 EPS 发生率（21%比 8%），并且在不同的药物和抗精神病药物类别之间存在差异。使用 FGA 或联合用药是抗胆碱能药物使用的一个关键预测因素。
