Boskailo Esad, Malkoc Aldin, McCurry Dustin B, Venter Jacob, Drachman David, Ramos Gilbert M
College of Medicine - Phoenix, The University of Arizona, Phoenix, Arizona, USA; Department of Psychiatry, Maricopa Integrated Health System, Phoenix, Arizona, USA.
Department of Psychiatry, Maricopa Integrated Health System, Phoenix, Arizona, USA; School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA; St. George's University School of Medicine, True Blue, Grenada.
Acta Med Acad. 2017 Nov;46(2):133-144. doi: 10.5644/ama2006-124.198.
Patients are frequently prescribed multiple antipsychotic medications, leading to higher healthcare costs and increased risk for side effects. The efficacy of multiple versus single antipsychotics to prevent acute relapse, measured by incidence of inpatient readmission, is investigated in Arizona, USA.
A retrospective chart review compared socio-demographic and clinical data from 1,010 patients discharged on a single and 377 discharged on multiple antipsychotic medications. Case management records were reviewed for readmission within one year of discharge.
Younger age, diagnosis of Schizophrenia or Schizoaffective Disorder, prescription of mood stabilizer, shorter length of stay, and discharge to residential treatment or crisis recovery unit were associated with multiple antipsychotics at discharge. Readmission rates of the single (13.7%) versus multiple (15.9%) antipsychotic groups were not statistically different (p=0.286). Logistic regression analysis established that only age (younger) and the prescription of a mood stabilizer at discharge were significant predictors for increased risk for readmission (p=0.010 and p=0.049, respectively). A Cox survival analysis supported these findings.
Concomitant antipsychotic polypharmacy at discharge did not reduce readmission risk over a one-year period. Given the increased risk of side effects and financial costs of polypharmacy, this study did not provide evidence to support this practice. Strikingly, only two variables predicted readmission risk, younger age and prescription of mood stabilizer. Although practitioners should follow practice guidelines more closely to prevent unnecessary exposure to potentially lethal side effects of antipsychotic polypharmacy, further studies are needed to better identify patients at high risk for readmission.
患者经常被开具多种抗精神病药物，这导致更高的医疗成本和副作用风险增加。在美国亚利桑那州，研究了多种抗精神病药物与单一抗精神病药物预防急性复发的疗效（通过住院再入院率衡量）。
一项回顾性病历审查比较了1010名仅使用单一抗精神病药物出院患者和377名使用多种抗精神病药物出院患者的社会人口统计学和临床数据。审查病例管理记录以了解出院后一年内的再入院情况。
年龄较小、精神分裂症或分裂情感性障碍诊断、开具心境稳定剂、住院时间较短以及出院后入住寄宿治疗机构或危机康复单元与出院时使用多种抗精神病药物有关。单一抗精神病药物组（13.7%）与多种抗精神病药物组（15.9%）的再入院率在统计学上无差异（p=0.286）。逻辑回归分析表明，只有年龄（较小）和出院时开具心境稳定剂是再入院风险增加的显著预测因素（分别为p=0.010和p=0.049）。Cox生存分析支持了这些发现。
出院时联合使用多种抗精神病药物在一年内并未降低再入院风险。鉴于多药联用增加了副作用风险和经济成本，本研究未提供支持这种做法的证据。引人注目的是，只有两个变量可预测再入院风险，即年龄较小和开具心境稳定剂。尽管从业者应更严格地遵循实践指南以防止不必要地暴露于抗精神病药物多药联用的潜在致命副作用，但仍需要进一步研究以更好地识别再入院高风险患者。
