Hsu Yi-Chien, Chou Yu-Ching, Chang Hsin-An, Kao Yu-Chen, Huang San-Yuan, Tzeng Nian-Sheng
Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan ; School of Medicine, National Defense Medical Center, Taipei, Taiwan.
School of Public Health, National Defense Medical Center, Taipei, Taiwan.
Neuropsychiatr Dis Treat. 2015 Jan 27;11:225-32. doi: 10.2147/NDT.S75609. eCollection 2015.
Refractory major depressive disorder (MDD) is a serious problem leading to a heavy economic burden. Antipsychotic augmentation treatment with aripiprazole and quetiapine is approved for MDD patients and can achieve a high remission rate. This study aimed to examine how psychiatrists in Taiwan choose medications and how that choice is influenced by health insurance payments and administrative policy.
Descriptive study.
Eight questions about the choice of treatment strategy and atypical antipsychotics, and the reason to choose aripiprazole.
We designed an augmentation strategy questionnaire for psychiatrists whose patients had a poor response to antidepressants, and handed it out during the annual meeting of the Taiwanese Society of Psychiatry in October 2012. It included eight questions addressing the choice of treatment strategy and atypical antipsychotics, and the reason whether or not to choose aripiprazole as the augmentation antipsychotic.
Choosing antipsychotic augmentation therapy or switching to other antidepressant strategies for MDD patients with an inadequate response to antidepressants was common with a similar probability (76.1% vs 76.4%). The most frequently used antipsychotics were aripiprazole and quetiapine, however a substantial number of psychiatrists chose olanzapine, risperidone, and sulpiride. The major reason for not choosing aripiprazole was cost (52.1%), followed by insurance official policy audit and deletion in the claims review system (30.1%).
The prescribing behavior of Taiwanese psychiatrists for augmentation antipsy-chotics is affected by health insurance policy.
难治性重度抑郁症（MDD）是一个严重问题，会导致沉重的经济负担。阿立哌唑和喹硫平用于抗精神病药物增效治疗已被批准用于MDD患者，且可实现较高的缓解率。本研究旨在探讨台湾精神科医生如何选择药物，以及这种选择如何受到医疗保险支付和行政政策的影响。
描述性研究。
关于治疗策略和非典型抗精神病药物选择的八个问题，以及选择阿立哌唑的原因。
我们为其患者对抗抑郁药反应不佳的精神科医生设计了一份增效策略问卷，并于2012年10月在台湾精神医学会年会上发放。问卷包括八个问题，涉及治疗策略和非典型抗精神病药物的选择，以及是否选择阿立哌唑作为增效抗精神病药物的原因。
对于对抗抑郁药反应不足的MDD患者，选择抗精神病药物增效治疗或换用其他抗抑郁策略很常见，概率相近（76.1%对76.4%）。最常用的抗精神病药物是阿立哌唑和喹硫平，然而相当数量的精神科医生选择奥氮平、利培酮和舒必利。不选择阿立哌唑的主要原因是费用（52.1%），其次是保险官方政策审核以及理赔审核系统中的删除（30.1%）。
台湾精神科医生使用增效抗精神病药物的处方行为受到医疗保险政策的影响。
