From *Psychiatric Centre Copenhagen, Copenhagen, Denmark; and †The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks; ‡Albert Einstein College of Medicine, Bronx; §The Feinstein Institute for Medical Research, Manhasset; and ∥Hofstra North Shore LIJ School of Medicine, Hempstead, NY.
J ECT. 2013 Dec;29(4):271-6. doi: 10.1097/YCT.0b013e31828b34f6.
Antipsychotic polypharmacy (APP) is frequent, but its pattern is unknown in treatment-refractory schizophrenia-spectrum patients receiving electroconvulsive therapy (ECT).
We performed a retrospective chart review of ECT-treated inpatients hospitalized at 2 Danish University hospitals from 2003 to 2008, focusing on APP patterns in patients with schizophrenia-spectrum disorders (n = 79, 13.2%). In addition to univariate analyses, a multivariate logistic regression analysis was performed to identify independent predictors of APP.
Of 79 antipsychotic-treated patients (aged 48.6 ± 14.2 years; illness duration, 18.3 ± 10.6 years) ultimately treated with ECT, 86.1% received 2 or more psychotropic medications, including mood stabilizers (19.0%), antidepressants (32.9%), and APP (72.2%; 2 antipsychotics = 41.8%, 3 = 21.5%, 4-5 = 7.6%). Most patients received first-generation antipsychotic (FGA) + second-generation antipsychotic (SGA) (48.1%), followed by SGA + SGA (24.1%), SGA monotherapy (22.8%), and FGA monotherapy (5.1%). Individual antipsychotics included olanzapine (44.3%), risperidone (26.6%), clozapine (26.6%), quetiapine (22.1%), ziprasidone (13.9%), aripiprazole (10.1%), and sertindole (3.8%). Antipsychotic polypharmacy was associated with a greater number of FGAs (0.8 ± 0.7 vs 0.1 ± 0.4, P < 0.0001) and SGAs (1.7 ± 0.8 vs 0.8 ± 0.4, P < 0.0001), zuclopenthixol use (31.6% vs 0%, P = 0.0019), olanzapine use (52.6% vs 22.7%, P = 0.017), less serotonin-noradrenaline reuptake inhibitor use (3.5% vs 18.2%, P = 0.027), and a trend toward more good to excellent ECT response (86.0% vs 68.2%, P = 0.071). In the logistic regression analysis, APP was independently associated with a higher number of FGAs (P = 0.0002) and olanzapine use (P = 0.0098) (r = 0.314, P < 0.0001).
Only 22.6% of this treatment-refractory population received clozapine, yet 72.4% received APP. Following the results from our study as well as the general level of evidence, patients with refractory schizophrenia-spectrum disorder should receive clozapine or ECT before being tried on APP.
抗精神病药联合用药（APP）在接受电抽搐治疗（ECT）的难治性精神分裂症谱系患者中很常见，但具体模式尚不清楚。
我们对 2003 年至 2008 年在丹麦 2 所大学医院住院接受 ECT 治疗的患者进行了回顾性病历审查，重点关注精神分裂症谱系障碍患者（n=79，13.2%）的 APP 模式。除了单变量分析外，还进行了多变量逻辑回归分析，以确定 APP 的独立预测因素。
在最终接受 ECT 治疗的 79 名接受抗精神病药物治疗的患者（年龄 48.6±14.2 岁；病程 18.3±10.6 年）中，86.1%接受了 2 种或更多精神药物治疗，包括心境稳定剂（19.0%）、抗抑郁药（32.9%）和 APP（72.2%；2 种抗精神病药=41.8%，3 种=21.5%，4-5 种=7.6%）。大多数患者接受第一代抗精神病药（FGA）+第二代抗精神病药（SGA）（48.1%），其次是 SGA+SGA（24.1%）、SGA 单药治疗（22.8%）和 FGA 单药治疗（5.1%）。单独使用的抗精神病药包括奥氮平（44.3%）、利培酮（26.6%）、氯氮平（26.6%）、喹硫平（22.1%）、齐拉西酮（13.9%）、阿立哌唑（10.1%）和塞替啶（3.8%）。抗精神病药联合用药与 FGA 数量增加（0.8±0.7 与 0.1±0.4，P<0.0001）和 SGA 数量增加（1.7±0.8 与 0.8±0.4，P<0.0001）、使用佐氯平（31.6%与 0%，P=0.0019）、使用奥氮平（52.6%与 22.7%，P=0.017）、使用更少的 5-羟色胺-去甲肾上腺素再摄取抑制剂（3.5%与 18.2%，P=0.027）有关，且 ECT 反应良好至极好的趋势更高（86.0%与 68.2%，P=0.071）。在逻辑回归分析中，APP 与 FGA 数量增加（P=0.0002）和使用奥氮平（P=0.0098）独立相关（r=0.314，P<0.0001）。
尽管只有 22.6%的难治性人群接受了氯氮平治疗，但仍有 72.4%的患者接受了 APP。根据我们的研究结果和一般证据水平，应在尝试 APP 治疗之前，让难治性精神分裂症谱系障碍患者接受氯氮平或 ECT。
