非致命性过量用药后，与精神药物处方模式相关的复发性过量用药风险。
Risk of recurrent overdose associated with prescribing patterns of psychotropic medications after nonfatal overdose.
作者信息
Okumura Yasuyuki, Nishi Daisuke
机构信息
Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo.
Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.
出版信息
Neuropsychiatr Dis Treat. 2017 Mar 2;13:653-665. doi: 10.2147/NDT.S128278. eCollection 2017.
OBJECTIVE
We aimed to estimate risk of recurrent overdose associated with psychosocial assessment by psychiatrists during hospitalization for nonfatal overdose and prescribing patterns of psychotropic medications after discharge.
METHODS
A retrospective cohort study was conducted using a nationwide claims database in Japan. We classified patients aged 19-64 years hospitalized for nonfatal overdose between October 2012 and September 2013 into two cohorts: 1) those who had consulted a psychiatrist prior to overdose (n=6,790) and 2) those who had not (n=4,950). All patients were followed up from 90 days before overdose until 365 days after discharge.
RESULTS
Overall, 15.3% of patients with recent psychiatric treatment had a recurrent overdose within 365 days, compared with 6.0% of those without psychiatric treatment. Psychosocial assessment during hospital admission had no significant effect on subsequent overdose, irrespective of treatment by psychiatrists before overdose. There was a dose-response relationship for the association of benzodiazepine prescription after overdose with subsequent overdose in either cohort, even after accounting for average daily dosage of benzodiazepines before overdose and other confounders. In patients with recent psychiatric treatment, the cumulative proportion of recurrent overdose at 365 days was 27.7% for patients receiving excessive dosages of benzodiazepines, 22.0% for those receiving high dosages, 15.3% for those receiving normal dosages, and 7.6% for those receiving no benzodiazepines. In patients without psychiatric treatment, the cumulative proportion of recurrent overdose at 365 days was 24.3% for patients receiving excessive dosages of benzodiazepines, 18.0% for those receiving high dosages, 9.0% for those receiving normal dosages, and 4.1% for those receiving no benzodiazepines.
CONCLUSION
Lower dose of benzodiazepines after overdose is associated with lower risk of subsequent overdose.
目的
我们旨在评估因非致命性过量用药住院期间精神科医生进行的社会心理评估与复发性过量用药风险之间的关联，以及出院后精神药物的处方模式。
方法
利用日本全国性的索赔数据库进行了一项回顾性队列研究。我们将2012年10月至2013年9月期间因非致命性过量用药住院的19 - 64岁患者分为两个队列：1）过量用药前咨询过精神科医生的患者（n = 6790）和2）未咨询过精神科医生的患者（n = 4950）。所有患者从过量用药前90天开始随访至出院后365天。
结果
总体而言，近期接受过精神科治疗的患者中有15.3%在365天内出现复发性过量用药，而未接受精神科治疗的患者中这一比例为6.0%。入院时的社会心理评估对随后的过量用药没有显著影响，无论过量用药前是否接受过精神科医生的治疗。在任一队列中，过量用药后苯二氮䓬类药物处方与随后的过量用药之间存在剂量反应关系，即使在考虑了过量用药前苯二氮䓬类药物的平均日剂量和其他混杂因素之后。在近期接受过精神科治疗的患者中，365天时复发性过量用药的累积比例在接受过量剂量苯二氮䓬类药物的患者中为27.7%，接受高剂量的患者中为22.0%，接受正常剂量的患者中为15.3%，未接受苯二氮䓬类药物的患者中为7.6%。在未接受精神科治疗的患者中，365天时复发性过量用药的累积比例在接受过量剂量苯二氮䓬类药物的患者中为24.3%，接受高剂量的患者中为18.0%，接受正常剂量的患者中为9.0%，未接受苯二氮䓬类药物的患者中为4.1%。
结论
过量用药后较低剂量的苯二氮䓬类药物与随后较低的过量用药风险相关。
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