Li Qian, Xiang Yu-Tao, Su Yun-Ai, Shu Liang, Yu Xin, Chiu Helen Fk, Correll Christoph U, Ungvari Gabor S, Lai Kelly Yc, Ma Cui, Wang Gao-Hua, Bai Pei-Shen, Li Tao, Sun Li-Zhong, Shi Jian-Guo, Chen Xian-Sheng, Mei Qi-Yi, Li Ke-Qing, Si Tian-Mei
The Key Laboratory of Mental Health, Ministry of Health & Peking University Institute of Mental Health, Beijing, China.
Faculty of Health Sciences, University of Macau, Macao SAR, China.
Aust N Z J Psychiatry. 2015 Feb;49(2):129-36. doi: 10.1177/0004867414536931. Epub 2014 Jun 12.
This study examined the use, demographic and clinical correlates of antipsychotic polypharmacy (APP) and its associations with treatment satisfaction and quality of life (QOL) in schizophrenia patients in China.
A total of 4239 patients in 45 nationwide Chinese psychiatric hospitals/centers were interviewed in 2012 in the third cross-sectional study, with the first two having been conducted in 2002 and 2006. Patients' socio-demographic and clinical characteristics, including psychopathology, side effects, satisfaction with treatment and QOL, were recorded using a standardized protocol and data collection procedure.
The proportion of APP prescriptions in 2012 was 34.2%, which was significantly higher than the frequency of APP in 2002 (26.1%) and 2006 (26.4%) (p<0.001). Of patients on APP, 91.1% received two antipsychotics, 8.6% received three and 0.3% received four or more antipsychotics. Multiple logistic regression analyses revealed that compared to those on antipsychotic monotherapy, patients on APP and their families had lower satisfaction with treatment, had higher QOL in the mental domain, younger age of onset, more side effects, higher doses of antipsychotics and were more likely to receive first-generation antipsychotics and less likely to receive benzodiazepines (total R (2)=0.31, p<0.001).
APP was found in about one in three schizophrenia patients. The prevalence of APP seems to have been increasing since 2002. Considering the increased frequency of drug-induced side effects and the patients' and their relatives' dissatisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of APP and its alternatives is warranted.
本研究探讨了中国精神分裂症患者中抗精神病药物联合使用（APP）的情况、人口统计学及临床相关因素，及其与治疗满意度和生活质量（QOL）的关联。
2012年在全国45家精神科医院/中心对4239例患者进行了访谈，这是第三次横断面研究，前两次分别在2002年和2006年进行。使用标准化方案和数据收集程序记录患者的社会人口学和临床特征，包括精神病理学、副作用、治疗满意度和生活质量。
2012年APP处方比例为34.2%，显著高于2002年（26.1%）和2006年（26.4%）（p<0.001）。在接受APP治疗的患者中，91.1%使用了两种抗精神病药物，8.6%使用了三种，0.3%使用了四种或更多抗精神病药物。多项逻辑回归分析显示，与接受抗精神病药物单一治疗的患者相比，接受APP治疗的患者及其家属对治疗的满意度较低，在心理领域的生活质量较高，发病年龄较轻，副作用较多，抗精神病药物剂量较高，更有可能接受第一代抗精神病药物，不太可能接受苯二氮䓬类药物（总R（2）=0.31，p<0.001）。
约三分之一的精神分裂症患者存在APP情况。自2002年以来，APP的患病率似乎一直在上升。考虑到药物引起的副作用增加以及患者及其亲属对抗精神病药物治疗的不满，有必要进一步研究APP及其替代方案的合理性和适用性。
