Schwartz Elana, Charlotte Melanie, Slade Eric, Medoff Deborah, Li Lan, Dixon Lisa, Kilbourne Amy, Kreyenbuhl Julie
VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore MD, 21201, USA.
University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, Baltimore MD, 21201, USA.
Gen Hosp Psychiatry. 2015 Jul-Aug;37(4):347-51. doi: 10.1016/j.genhosppsych.2015.03.018. Epub 2015 Apr 1.
To examine gender differences in prescribing of antipsychotic medications (APMs) according to their liability for weight gain and other metabolic side effects.
We identified 4510 patients with schizophrenia or bipolar disorders receiving usual care in a Veterans Affairs (VA) health care network in the U.S. mid-Atlantic region who initiated treatment with an APM between October 2006 and September 2011. We used multivariable logistic regression to examine gender differences in the likelihood of incident prescription of APMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and selected Veteran demographic, mental health and physical health characteristics.
Overall, 58% of women were prescribed an APM with a low risk of metabolic side effects compared to 45% of men (P<.001). In multivariable analysis, women Veterans were 1.47 times as likely as men to be prescribed a low-metabolic-risk APM (95% confidence interval: 1.26-1.73, P<.001). Several demographic and clinical covariates were also independently related to prescribing of APMs by level of metabolic risk.
The results may suggest that prescribing choices for APMs by VA mental health prescribers and female Veterans reflect a growing awareness of the potential adverse health consequences of these treatments in women.
根据抗精神病药物（APMs）导致体重增加及其他代谢副作用的可能性，研究其处方中的性别差异。
我们在美国中大西洋地区退伍军人事务部（VA）医疗保健网络中，确定了4510例接受常规护理的精神分裂症或双相情感障碍患者，这些患者在2006年10月至2011年9月期间开始使用APM进行治疗。我们使用多变量逻辑回归分析，在调整处方财政年度以及选定的退伍军人人口统计学、心理健康和身体健康特征后，研究开具低代谢风险与中/高代谢风险APM的可能性中的性别差异。
总体而言，58%的女性患者被开具代谢副作用风险较低的APM，而男性患者这一比例为45%（P<0.001）。在多变量分析中，女性退伍军人被开具低代谢风险APM的可能性是男性的1.47倍（95%置信区间：1.26 - 1.73，P<0.001）。一些人口统计学和临床协变量也与按代谢风险水平开具APM独立相关。
结果可能表明，VA心理健康处方医生和女性退伍军人在APM处方选择上，反映出对这些治疗方法在女性中潜在健康不良后果的认识不断提高。
