Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Division of Rehabilitation & Community Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.
Psychiatry Clin Neurosci. 2019 Aug;73(8):501-507. doi: 10.1111/pcn.12861. Epub 2019 Jun 17.
Antipsychotics off-label use is common in clinical practice but information is limited in regards to the trends of antipsychotic use in specific mental disorders in Taiwan. This study aimed to examine the trends and associated factors of antipsychotic use among outpatients with anxiety disorders in Taiwan during 2005-2013.
We assessed the annual prescriptions of antipsychotic use in nine consecutive years (2005-2013) using the National Health Insurance Research Database among adults (aged ≥18 years) with anxiety disorders in outpatient visits in Taiwan. We applied logistic regression to examine the trends and associated factors of antipsychotic use.
The proportion of antipsychotic medication use for anxiety disorder increased from 8.4% in 2005 to 9.1% in 2013. First-generation antipsychotics (FGA) use was more than that of second-generation antipsychotics (SGA) use in patients with anxiety disorder through the 9-year period. Sulpiride and flupentixol were the two most common FGA in the treatment of anxiety disorder. Patients with specific anxiety disorder (post-traumatic stress disorder, panic disorder/agoraphobia, generalized anxiety disorder, and obsessive-compulsive disorder), female sex, younger age (age < 65 years), comorbidity with major depression or minor depression, antidepressants concurrent use, and visits to psychiatrists, medical centers and primary care were significantly more likely to take prescribed antipsychotics.
Antipsychotic off-label use significantly increased among patients with anxiety disorder in this national representative cohort. Such increased use of antipsychotics could be driven by augmentation of their prescription for major depression. As their efficacy and safety remain uncertain, further study is warranted.
抗精神病药的超适应证使用在临床实践中很常见，但关于台湾特定精神障碍中抗精神病药使用趋势的信息有限。本研究旨在考察 2005-2013 年台湾门诊焦虑障碍患者抗精神病药使用的趋势和相关因素。
我们使用台湾全民健康保险研究数据库，评估了 9 年来（2005-2013 年）连续 9 年门诊就诊的成年（年龄≥18 岁）焦虑障碍患者的抗精神病药年度处方情况。我们应用逻辑回归分析考察了抗精神病药使用的趋势和相关因素。
抗精神病药治疗焦虑障碍的比例从 2005 年的 8.4%上升到 2013 年的 9.1%。在 9 年期间，焦虑障碍患者中第一代抗精神病药（FGA）的使用多于第二代抗精神病药（SGA）。在治疗焦虑障碍时，舒必利和氟哌啶醇是两种最常用的 FGA。特定焦虑障碍（创伤后应激障碍、惊恐障碍/广场恐惧症、广泛性焦虑障碍和强迫症）、女性、年龄较小（年龄<65 岁）、合并重度或轻度抑郁症、合并使用抗抑郁药、就诊于精神科医生、医疗中心和基层医疗机构的患者更有可能开具抗精神病药处方。
在这个全国代表性队列中，焦虑障碍患者的抗精神病药超适应证使用显著增加。这种抗精神病药使用的增加可能是由于其治疗重度抑郁症的处方增加所致。由于其疗效和安全性仍不确定，因此需要进一步研究。
