Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip code 45170, Zapopan, Jalisco, México.
Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra mojada 950 Colonia independencia, Zip code 44340, Guadalajara, Jalisco, México.
BMC Psychiatry. 2019 Feb 21;19(1):78. doi: 10.1186/s12888-019-2056-0.
Polypharmacy increases the risk of pharmacological interactions, prevalence of secondary effects and with this the lack of adherence to treatment. It is estimated that between 10 and 40% of patients hospitalized in psychiatric institutions are prescribed more than one antipsychotic. The objective of the present study was to identify the prevalence of polypharmacy, evaluate adverse effects associated to the use of psych drugs and to estimate the risk in specific groups.
We carried out a longitudinal, retrospective study that included the analysis of all discharged patients (n = 140) in the first trimester of the year in a psychiatric hospital in Mexico. The information was classified into 7 sections: sociodemographic, diagnosis, clinical follow-up information, prescribed drugs, adverse reactions, substance abuse, laboratory and complementary results. Risk estimation was obtained with Odds Ratios, to correlate continuous variables Pearson's correlation was used. Student's T and Mann Whitney's U were used to compare 2 independent samples; multiple and linear regressions were carried out.
The mean number of drugs used during hospitalization was 7.8 drugs per patient. The mean prescribed psych drugs was 4.07. The mean antipsychotic dose was the risperidone equivalent of 5.08 mg. 29.2% of patients had at least one secondary effect associated to the use of drugs, 17.8% presented extrapyramidal symptoms. 81.4% of patients were prescribed 6 or more drugs (polypharmacy) and were 5 times more likely to suffer a secondary effects (OR 6.24). 14.2% had polypharmacy while receiving antipsychotics and had more than twice the risk of presenting extrapyramidal symptoms (OR 3.05). For each added psych drug, hospital stay increased by 6.56 days.
Despite international guideline recommendations where reasoned and conciliatory prescription of psych drugs is advised, there is still a high prevalence of polypharmacy in patients hospitalized in psychiatric institutions. In the present study 4 out of 5 patients received polypharmacy decreasing tolerability, treatment adherence and increasing the risk and costs secondary to an increased hospital stay.
药物的联合使用会增加药物相互作用、不良反应发生的风险，进而导致治疗依从性降低。据估计，在精神病院住院的患者中，有 10%至 40%同时使用了不止一种抗精神病药物。本研究旨在确定精神科住院患者药物联合使用的发生率，评估与精神药物使用相关的不良反应，并评估特定人群的风险。
我们开展了一项纵向、回顾性研究，纳入了墨西哥一家精神病院在第一季度出院的所有患者（n=140）。将信息分为 7 个部分：社会人口学、诊断、临床随访信息、处方药物、不良反应、物质滥用、实验室和补充检查结果。使用比值比（OR）进行风险估计，使用 Pearson 相关系数对连续变量进行相关性分析。使用学生 t 检验和曼-惠特尼 U 检验比较两组独立样本；进行多元和线性回归分析。
住院期间平均使用药物 7.8 种，平均使用精神药物 4.07 种，平均抗精神病药物剂量相当于利培酮 5.08mg。29.2%的患者出现至少一种与药物使用相关的不良反应，17.8%出现锥体外系症状。81.4%的患者服用了 6 种或更多药物（联合用药），发生不良反应的可能性增加了 5 倍（OR 6.24）。14.2%的患者在使用抗精神病药物时同时接受了联合用药，出现锥体外系症状的风险增加了两倍以上（OR 3.05）。每增加一种精神药物，住院时间延长 6.56 天。
尽管国际指南建议合理和调和地开具精神药物，但精神科住院患者的药物联合使用仍很普遍。在本研究中，有 4/5 的患者接受了联合用药，导致耐受性降低、治疗依从性降低，并因住院时间延长而增加了不良反应的风险和成本。
