Horowitz Einav, Bergman Lisa Carroll, Ashkenazy Charna, Moscona-Hurvitz Irit, Grinvald-Fogel Haya, Magnezi Racheli
Israeli Center for Technology Assessment in Health Care, Gertner Institute, Haim Sheba Medical Center, Ramat Gan, Israel.
Public Health and Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel.
PLoS One. 2014 Mar 24;9(3):e92573. doi: 10.1371/journal.pone.0092573. eCollection 2014.
Off-label use of a drug not according to its regulatory labeling has become common in medicine, especially in the field of psychiatry. Mood stabilizers are intended to be used to attenuate mood fluctuations in bipolar disorder, but their use has spread to patients with schizophrenia, as it provides greater control of impulsivity and aggressiveness. Sodium valproate is one of the most frequently used mood stabilizers in psychiatry. This study determined the prevalence of off-label use of sodium valproate for schizophrenia and schizoaffective disorder in Abarbanel Psychiatric Hospital and the demographic and clinical characteristics associated with its use.
Retrospective study of patients hospitalized in 2011-2012 with a diagnosis of schizophrenia or schizoaffective disorder in one of three general psychiatric wards.
Valproate use was significantly lower in the geriatric group (11.6% vs. 20.1%, chi square = 4.7, p = .03), in patients with schizophrenia (14.1% vs. schizoaffective disorder (35.2%), chi square = 29, p<.001) and in patients receiving both atypical and typical antipsychotics (23.3% vs. 16.4%, p = .04). In multivariate logistic regression analysis, diagnosis and the combination of atypical and typical antipsychotics predicted the use of sodium valproate. The number of other medications prescribed did not predict sodium valproate use.
Off-label use of sodium valproate in psychiatric patients with schizophrenia or schizoaffective disorder is extensive, especially in younger patients and those with schizoaffective disorder. More research is needed to determine whether it is being prescribed appropriately.
药物未按照监管标签进行的非标签使用在医学中已很常见，尤其是在精神病学领域。心境稳定剂旨在用于减轻双相情感障碍中的情绪波动，但它们的使用已扩展到精神分裂症患者，因为其能更好地控制冲动性和攻击性。丙戊酸钠是精神病学中最常用的心境稳定剂之一。本研究确定了阿巴巴内尔精神病医院中丙戊酸钠用于精神分裂症和分裂情感性障碍的非标签使用情况及其使用相关的人口统计学和临床特征。
对2011 - 2012年在三个普通精神科病房之一住院且诊断为精神分裂症或分裂情感性障碍的患者进行回顾性研究。
老年组丙戊酸钠的使用显著较低（11.6%对20.1%，卡方 = 4.7，p = 0.03），精神分裂症患者中（14.1%对分裂情感性障碍患者中的35.2%，卡方 = 29，p < 0.001）以及同时接受非典型和典型抗精神病药物治疗的患者中（23.3%对16.4%，p = 0.04）。在多因素逻辑回归分析中，诊断以及非典型和典型抗精神病药物的联合使用可预测丙戊酸钠的使用。所开其他药物的数量不能预测丙戊酸钠的使用。
丙戊酸钠在患有精神分裂症或分裂情感性障碍的精神病患者中的非标签使用广泛，尤其是在年轻患者和患有分裂情感性障碍的患者中。需要更多研究来确定其处方是否恰当。
