Berling Ingrid, Buckley Nicholas A, Isbister Geoffrey K
Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, NSW, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
Br J Clin Pharmacol. 2016 Jul;82(1):249-54. doi: 10.1111/bcp.12927. Epub 2016 Apr 15.
Morbidity and mortality from drug overdose has decreased over three decades. This is credited to safer drugs and therefore better outcomes in overdose. We aimed to investigate changing prescriptions of antipsychotic medications and associated changes in antipsychotic overdoses over a 26-year period.
All antipsychotic poisoning presentations to a tertiary referral toxicology unit between 1987 and 2012 were reviewed. Data were collected prospectively on demographics, ingestion information, clinical effects, complications and treatment. Rates of antipsychotic drug use in Australia were obtained from Australian government publications for 1990-2011 and linked to overdose admissions by postcode.
There were 3180 antipsychotic overdoses: 1235 first generation antipsychotics, 1695 'atypical' second generation antipsychotics and 250 lithium overdoses. Over 26 years, antipsychotic overdoses increased 1.8-fold, with first generation antipsychotics decreasing to one-fifth of their peak (≈80/year to 16) and second generation antipsychotics increasing to double this (≈160/year), olanzapine and quetiapine accounting for 78%. All antipsychotic overdoses had a median length of stay of 18.6 h, 15.7% admitted to intensive care unit, 10.4% ventilated and 0.13% died in hospital, which was the same for first generation compared to second generation antipsychotics. There was a 2.3-fold increase in antipsychotic prescriptions over the same period; first generation antipsychotics declined whereas there was a dramatic rise in second generation antipsychotics, mainly olanzapine, quetiapine and risperidone (79%).
Over 26 years there was an increase in antipsychotic prescribing associated with an increase in antipsychotic overdoses. Although the type of antipsychotics changed, the morbidity and mortality remained the same, so that antipsychotics are an increasing proportion of overdose admissions.
药物过量导致的发病率和死亡率在过去三十年中有所下降。这归功于药物安全性的提高，从而使过量用药的后果得到改善。我们旨在调查26年间抗精神病药物处方的变化以及抗精神病药物过量使用的相关变化。
回顾了1987年至2012年间所有向三级转诊毒理学单位报告的抗精神病药物中毒病例。前瞻性收集了人口统计学、摄入信息、临床效应、并发症和治疗方面的数据。澳大利亚1990 - 2011年抗精神病药物的使用比率来自澳大利亚政府出版物，并通过邮政编码与过量用药入院情况相关联。
共有3180例抗精神病药物过量使用病例：1235例第一代抗精神病药物过量，1695例“非典型”第二代抗精神病药物过量，250例锂盐过量。在26年期间，抗精神病药物过量使用病例增加了1.8倍，第一代抗精神病药物降至其峰值的五分之一（约从每年80例降至16例），第二代抗精神病药物增加至两倍（约从每年160例），其中奥氮平和喹硫平占78%。所有抗精神病药物过量使用病例的住院中位时长为18.6小时，15.7%入住重症监护病房，10.4%接受机械通气，0.13%在医院死亡，第一代和第二代抗精神病药物过量使用病例的上述情况相同。同期抗精神病药物处方量增加了2.3倍；第一代抗精神病药物减少，而第二代抗精神病药物急剧增加，主要是奥氮平、喹硫平和利培酮（占79%）。
在26年期间，抗精神病药物处方量增加，同时抗精神病药物过量使用病例也增加。尽管抗精神病药物的类型发生了变化，但发病率和死亡率保持不变，因此抗精神病药物在过量用药入院病例中所占比例越来越高。
