老年抑郁症患者中不典型抗精神病药物的处方应用。

Atypical antipsychotic prescribing in elderly patients with depression.

机构信息

Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, 1441 Moursund Street, Houston, TX, 77030, USA.

出版信息

Res Social Adm Pharm. 2018 Jul;14(7):645-652. doi: 10.1016/j.sapharm.2017.07.013. Epub 2017 Aug 2.

DOI:10.1016/j.sapharm.2017.07.013

PMID:28826692

Abstract

BACKGROUND

Atypical antipsychotics are used as monotherapy or as augmentation therapy for management of late-life depression. However, little is known about utilization pattern of atypical antipsychotics in depression in the elderly.

OBJECTIVE

The objective of this study was to examine the prescribing practices and predictors of atypical antipsychotics and augmentation therapy in elderly outpatient visits with depression.

METHODS

This retrospective cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) and outpatient department component of the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2010 and 2011. The study included elderly (age ≥ 65years) outpatient visits with depression. Descriptive weighted analysis was performed to determine the prescribing practices of atypical antipsychotics and multivariable logistic regression analyses were performed to determine the factors associated with the prescription of atypical antipsychotics and augmentation therapy in outpatient visits.

RESULTS

According to the national surveys, there were about 22 million outpatent visits for depression during the study period; atypical antipsychotics were prescribed in 3.53% (95% CI, 2.02-5.04) of the visits. Among depression patients who were using antidepressants, 4.86% (95% CI, 3.07-6.04) used as an augmentation therapy. Multivariable regression analysis revealed that Hispanics (odds ratio [OR] = 0.33; 95% CI, 0.12-0.90) were associated with decreased likelihood of antipsychotic prescription, whereas personality disorder and obsessive compulsive disorder (OR = 10.23; 95% CI, 2.80-37.40) were associated with increased likelihood of prescribing antipsychotics. For augmentation therapy, Hispanics (OR = 0.06; 95% CI, 0.02-0.24) and primary physicians (OR = 0.24; 95% CI, 0.09-0.69) were associated with decreased likelihood; and obsessive compulsive disorder and personality disorder (OR = 7.56; 95% CI, 1.75-32.69) were associated with increased likelihood of antipsychotic prescription.

CONCLUSION

Less than 4% of the elderly visits with depression were prescribed atypical antipsychotics. Both clinical and demographic factors contribute to antipsychotic prescribing in elderly patients with depression.

摘要

背景

非典型抗精神病药物被用作治疗老年人抑郁症的单药治疗或增效治疗。然而，关于老年人抑郁症中非典型抗精神病药物的使用模式知之甚少。

目的

本研究旨在探讨老年门诊抑郁症患者中使用非典型抗精神病药物和增效治疗的处方情况和预测因素。

方法

本回顾性横断面研究使用了 2010 年和 2011 年国家门诊医疗调查（NAMCS）和国家医院门诊医疗调查（NHAMCS）的门诊部分数据。研究包括年龄≥65 岁的门诊抑郁症患者。采用加权描述性分析确定非典型抗精神病药物的处方情况，采用多变量逻辑回归分析确定与门诊就诊时使用非典型抗精神病药物和增效治疗相关的因素。

结果

根据全国调查，研究期间约有 2200 万例门诊抑郁症就诊；3.53%（95%CI，2.02-5.04）的就诊患者开具了非典型抗精神病药物。在使用抗抑郁药的抑郁症患者中，4.86%（95%CI，3.07-6.04）将其作为增效治疗药物。多变量回归分析显示，西班牙裔（比值比[OR]＝0.33；95%CI，0.12-0.90）与抗精神病药物处方的可能性降低相关，而人格障碍和强迫症（OR＝10.23；95%CI，2.80-37.40）与开具抗精神病药物的可能性增加相关。对于增效治疗，西班牙裔（OR＝0.06；95%CI，0.02-0.24）和初级保健医生（OR＝0.24；95%CI，0.09-0.69）与可能性降低相关；而强迫症和人格障碍（OR＝7.56；95%CI，1.75-32.69）与抗精神病药物处方的可能性增加相关。