J Clin Psychopharmacol. 2018 Jun;38(3):180-187. doi: 10.1097/JCP.0000000000000876.
Current evidence-based guidelines provide unclear support for many common polypharmacy practices in schizophrenia. Excessive or complex polypharmacy (≥4 psychotropics) has been studied in patients with bipolar disorder, but not in schizophrenia to date.
We conducted a digital medical record data extraction of 829 patients consecutively admitted to a psychiatric hospital and diagnosed as having schizophrenia-spectrum disorders.
In those prescribed psychiatric medication preadmission, 28.1% (n = 169) met the criteria for complex polypharmacy. Complex polypharmacy patients were older, female, white, and disabled, and had more comorbidities compared with those without complex polypharmacy. In multivariable analysis, complex polypharmacy was specifically associated with being white and disabled, and having a comorbid anxiety disorder, tobacco use disorder, metabolic condition, and neurological condition compared with noncomplex polypharmacy patients.
Although there is little evidence to support complex polypharmacy in schizophrenia, rates were relatively high in patients requiring hospitalization, especially when they are also diagnosed as having comorbid psychiatric and medical conditions. Future research is needed to study the risk-benefit profile for these patients, especially considering their higher medical burden and related health risks.
目前的循证指南并未明确支持精神分裂症中许多常见的联合用药实践。目前已经研究了双相情感障碍患者中过度或复杂的联合用药（≥4 种精神药物），但尚未在精神分裂症患者中进行研究。
我们对连续入住精神病院并诊断为精神分裂症谱系障碍的 829 名患者进行了数字病历数据提取。
在入院前接受精神药物治疗的患者中，有 28.1%（n=169）符合复杂联合用药的标准。与非复杂联合用药患者相比，复杂联合用药患者年龄更大、女性、白人、残疾，且合并症更多。在多变量分析中，与非复杂联合用药患者相比，复杂联合用药与白人、残疾以及合并焦虑障碍、烟草使用障碍、代谢状况和神经状况相关。
尽管在精神分裂症中很少有证据支持复杂的联合用药，但在需要住院治疗的患者中，这一比例相对较高，尤其是当他们还被诊断为合并有精神和躯体疾病时。需要进一步研究这些患者的风险效益特征，尤其是考虑到他们更高的医疗负担和相关健康风险。
