Heald Adrian, Livingston Mark, Yung Alison, De Hert M A
School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Department of Medicine, Leighton Hospital, Crewe, UK.
Hum Psychopharmacol. 2017 Mar;32(2). doi: 10.1002/hup.2579.
Diabetes, obesity, and metabolic syndrome are highly prevalent in patients with severe mental illness. Psychotropic polypharmacy is becoming increasingly prevalent within the UK. We determined the change in the number of psychotropic medications prescribed over time and trends in weight and fasting blood glucose.
One hundred ninety-five individuals with schizophrenia and psychosis on the Severe Mental Illness Register in Cheshire, UK, were followed up between 2004 and 2012. Individuals were identified through a semianonymised search of general practitioner registers.
The total number of different medications prescribed increased from 140 in 2004 to 226 in 2012 with the mean number of medication groups per patient increasing from 0.71 to 1.15 (p < .001). The number of individuals on no medication reduced from 58.0% to 33.3%, OR 0.36 95% CI [0.24, 0.54], and those prescribed one medication increased from 20.5% to 31.8%, OR 1.93 95% CI [1.22-3.06]. Baseline body mass index was 28.9, increasing to 30.8 at 8-year follow-up, F(6.5), p = .003, with a significant corresponding increase in fasting blood glucose.
In conclusion, we determined an increase in psychotropic polypharmacy over the follow-up period. Body mass index or fasting blood glucose increased over time. Clozapine and depot antipsychotic prescriptions were often not recorded in the general practitioner records.
糖尿病、肥胖症和代谢综合征在重症精神疾病患者中极为普遍。在英国，联合使用多种精神药物的情况日益常见。我们确定了随时间推移开具的精神药物数量的变化以及体重和空腹血糖的趋势。
对英国柴郡严重精神疾病登记册上的195名精神分裂症和精神病患者在2004年至2012年期间进行了随访。通过对全科医生登记册进行半匿名搜索来确定这些个体。
所开具的不同药物总数从2004年的140种增加到2012年的226种，每位患者的药物组平均数量从0.71增加到1.15（p <.001）。未用药的个体数量从58.0%降至33.3%，比值比为0.36，95%置信区间为[0.24, 0.54]，而开具一种药物的个体数量从20.5%增加到31.8%，比值比为1.93，95%置信区间为[1.22 - 3.06]。基线体重指数为28.9，在8年随访时增至30.8，F(6.5)，p =.003，空腹血糖也相应显著增加。
总之，我们发现在随访期间联合使用多种精神药物的情况有所增加。体重指数或空腹血糖随时间增加。氯氮平和长效抗精神病药物的处方在全科医生记录中常常未被记录。
