Wu Yu-Hsuan, Lai Chun-Yang, Chang Yu-San
Department of Neuropsychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
Psychogeriatrics. 2015 Mar;15(1):7-13. doi: 10.1111/psyg.12067. Epub 2014 Dec 17.
This study was to investigate the prescribing patterns for antipsychotic drugs in elderly hospitalized patients with a diagnosis of schizophrenia or dementia at a psychiatric hospital in Taiwan from 2007 to 2012. This study also explored the predictors of antipsychotic polypharmacy (APP).
We collected patients' demographic data, including year of admission, age, gender, and length of hospital stay, and drug-related information.
Second-generation antipsychotic (SGA) monotherapy was the most common type of therapy in both those with dementia and with schizophrenia, and quetiapine and risperidone were the most commonly prescribed drugs for these conditions, respectively. In late-life schizophrenia, 33.8% of the patients used first-generation antipsychotics (FGA) alone. Regarding APP, a combination of FGA and SGA and combinations of SGA were most commonly noted in schizophrenia patients and dementia patients, respectively. Overall, APP increased from 2007 to 2012. It was significantly more common in patients with dementia (odds ratio: 3.49, 95% confidence interval: 1.29-9.39, P = 0.014), less concurrent use of hypnotics and sedatives (odds ratio: 0.41, 95% confidence interval: 0.17-0.99, P = 0.046), and a higher-than-recommended dose of antipsychotic drugs (odds ratio: 4.98, 95% confidence interval: 2.75-9.02, P < 0.001).
FGA are still commonly used for the late-life schizophrenia at our hospital. Given their potentially hazardous side effects, FGA must be employed with caution. The use of APP involving SGA increased over the 6 years of the study period, especially among patients with dementia. However, the use of SGA in dementia began to decline after the US Food and Drug Administration's 2005 warning about SGA being associated with increased mortality in dementia patients, which contrasts with the trends examined in this study. Further controlled trials exploring the efficacy, safety, and tolerability of APP in this population are warranted to gain an additional insight into this practice.
本研究旨在调查2007年至2012年台湾一家精神病院确诊为精神分裂症或痴呆症的老年住院患者使用抗精神病药物的处方模式。本研究还探讨了抗精神病药物联合使用（APP）的预测因素。
我们收集了患者的人口统计学数据，包括入院年份、年龄、性别和住院时间，以及与药物相关的信息。
在患有痴呆症和精神分裂症的患者中，第二代抗精神病药物（SGA）单药治疗是最常见的治疗类型，喹硫平和利培酮分别是这些病症最常处方的药物。在老年精神分裂症患者中，33.8%的患者单独使用第一代抗精神病药物（FGA）。关于APP，FGA与SGA联合使用以及SGA联合使用在精神分裂症患者和痴呆症患者中最为常见。总体而言，APP从2007年到2012年有所增加。在痴呆症患者中更为常见（优势比：3.49，95%置信区间：1.29 - 9.39，P = 0.014），同时使用催眠药和镇静剂的情况较少（优势比：0.41，95%置信区间：0.17 - 0.99，P = 0.046），且抗精神病药物剂量高于推荐剂量（优势比：4.98，95%置信区间：2.75 - 9.02，P < 0.001）。
在我院，FGA仍常用于老年精神分裂症患者。鉴于其潜在的有害副作用，必须谨慎使用FGA。在研究的6年期间，涉及SGA的APP使用有所增加，尤其是在痴呆症患者中。然而，在美国食品药品监督管理局2005年警告SGA与痴呆症患者死亡率增加有关后，痴呆症患者中SGA的使用开始下降，这与本研究中考察的趋势形成对比。有必要进行进一步的对照试验，以探究APP在该人群中的疗效、安全性和耐受性，以便对这种做法有更深入的了解。
