Lopez Leonardo V, Shaikh Atef, Merson Jonathan, Greenberg Jessica, Suckow Raymond F, Kane John M
From the *Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks; †Department of Psychiatry, The Hofstra Northwell School of Medicine, Hempstead; ‡New York State Psychiatric Institute, Columbia University College of Physicians & Surgeons, New York; and §Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY.
J Clin Psychopharmacol. 2017 Jun;37(3):310-314. doi: 10.1097/JCP.0000000000000697.
The present study aimed to assess the level of agreement between clinicians' routine assessments of medication status and plasma levels of commonly prescribed antipsychotic medications in patients presenting to an emergency room with an exacerbation of psychosis.
We studied 105 patients presenting to an emergency room and admitted to an inpatient psychiatric unit with a diagnosis of schizophrenia, schizoaffective disorder, bipolar I disorder, or psychotic disorder not otherwise specified and a prior outpatient medication regimen including risperidone, olanzapine, quetiapine, aripiprazole, or paliperidone. Plasma levels of antipsychotics were drawn and sent to a specialty laboratory for testing.
Of the 97 patients with usable samples, 33 (34%) were found to have therapeutic antipsychotic levels. Of these, 22 were judged by emergency room staff to be taking their medications at the appropriately prescribed doses, whereas 11 were judged not to be taking medication at all. Sixty-four patients were found to have subtherapeutic antipsychotic levels, 31 of whom had been assessed to be taking medication as prescribed. Emergency assessment of medication status predicted therapeutic and nontherapeutic antipsychotic levels at rates of 41.5% and 75%, respectively. Emergency staff assessment was statistically independent from the likelihood of having a therapeutic antipsychotic level.
In patients presenting to emergency rooms with exacerbations of psychosis who are subsequently admitted to an inpatient facility, common assessments of medication status are frequently misleading. Readily available methods for rapidly measuring antipsychotic plasma levels in clinical settings are needed for clinicians to make reliable assessments.
本研究旨在评估临床医生对前来急诊室且精神病病情加重患者的用药状况常规评估与常用抗精神病药物血浆水平之间的一致性。
我们研究了105名前来急诊室并入住住院精神科病房的患者，这些患者被诊断为精神分裂症、分裂情感性障碍、双相I型障碍或未另行说明的精神障碍，且之前有包括利培酮、奥氮平、喹硫平、阿立哌唑或帕利哌酮在内的门诊用药方案。采集抗精神病药物的血浆水平并送往专业实验室进行检测。
在97名有可用样本的患者中，33名（34%）被发现抗精神病药物水平处于治疗范围。其中，22名被急诊室工作人员判定按适当规定剂量服药，而11名被判定根本未服药。64名患者被发现抗精神病药物水平低于治疗范围，其中31名被评估为按规定服药。用药状况的急诊评估预测治疗性和非治疗性抗精神病药物水平的准确率分别为41.5%和75%。急诊工作人员的评估在统计学上与抗精神病药物达到治疗水平的可能性无关。
对于前来急诊室且精神病病情加重随后入住住院机构的患者，用药状况的常规评估常常具有误导性。临床医生需要有在临床环境中快速测量抗精神病药物血浆水平的现成方法，以便进行可靠评估。
