Department of Psychiatry, Huzhou 3rd Hospital, Huzhou, 313000, Zhejiang, China.
Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing, 100191, China.
BMC Psychiatry. 2019 Jul 10;19(1):216. doi: 10.1186/s12888-019-2192-6.
Data on the pharmacological management of acute agitation in schizophrenia are scarce. The aim of this study is to investigate the prescription practices in the treatment of agitation in Chinese patients with schizophrenia.
We conducted a large, multicenter, observational study in 14 psychiatry hospitals in China. Newly hospitalized schizophrenia patients with the PANSS-EC total score ≥ 14 and a value ≥4 on at least one of its five items were included in the study. Their drug treatments of the first 2 weeks in hospital were recorded by the researchers.
Eight hundred and 53 patients enrolled in and 847 (99.30%) completed the study. All participants were prescribed antipsychotics, 40 (4.72%) were prescribed benzodiazepine in conjunction with antipsychotics and 81 were treated with modified electric convulsive therapy (MECT). Four hundred and 12 (48.64%) patients were prescribed only one antipsychotic, in the order of olanzapine (120 patients, 29.13%), followed by risperidone (101 patients, 24.51%) and clozapine (41 patients, 9.95%). About 435 (51.36%) participants received antipsychotic polypharmacy, mostly haloperidol + risperidone (23.45%), haloperidol+ olanzapine (17.01%), olanzapine+ ziprasidone (5.30%), haloperidol + clozapine (4.37%) and haloperidol + quetiapine (3.90%). Binary logistic regression analysis suggests that a high BARS score (OR 2.091, 95%CI 1.140-3.124), severe agitation (OR 1.846, 95%CL 1.266-2.693), unemployment or retirement (OR 1.614, 95%CL 1.189-2.190) and aggressiveness on baseline (OR 1.469, 95%CL 1.032-2.091) were related to an increased antipsychotic polypharmacy odds. Male sex (OR 0.592, 95%CL 0.436-0.803) and schizophrenia in older persons (age ≥ 55 years, OR 0.466, 95%CL 0.240-0.902) were less likely to be associated with antipsychotic polypharmacy.
The present study demonstrates that monotherapy and polypharmacy display equally common patterns of antipsychotic usage in managing agitation associated with schizophrenia in China. The extent and behavioral activities of agitation and several other factors were associated with polypharmacy.
关于精神分裂症急性激越的药物治疗数据较为匮乏。本研究旨在调查中国精神分裂症患者激越治疗中的处方实践。
我们在中国 14 家精神病院进行了一项大型、多中心、观察性研究。纳入新入院、PANSS-EC 总分≥14 分且总分≥4 分的至少一项分测验的精神分裂症患者，并记录他们入院后前 2 周的药物治疗情况。
853 例患者入组，847 例（99.30%）完成研究。所有患者均接受了抗精神病药物治疗，40 例（4.72%）联合使用苯二氮䓬类药物，81 例接受了改良电抽搐治疗（MECT）。412 例（48.64%）患者仅接受一种抗精神病药物治疗，依次为奥氮平（120 例，29.13%）、利培酮（101 例，24.51%）和氯氮平（41 例，9.95%）。约 435 例（51.36%）患者接受了抗精神病药联合治疗，主要为氟哌啶醇+利培酮（23.45%）、氟哌啶醇+奥氮平（17.01%）、奥氮平+齐拉西酮（5.30%）、氟哌啶醇+氯氮平（4.37%）和氟哌啶醇+喹硫平（3.90%）。二元逻辑回归分析表明，较高的 BARS 评分（OR 2.091，95%CI 1.140-3.124）、严重激越（OR 1.846，95%CI 1.266-2.693）、失业或退休（OR 1.614，95%CI 1.189-2.190）以及基线时的攻击性（OR 1.469，95%CI 1.032-2.091）与抗精神病药联合治疗的可能性增加相关。男性（OR 0.592，95%CI 0.436-0.803）和老年精神分裂症（年龄≥55 岁，OR 0.466，95%CI 0.240-0.902）不太可能与抗精神病药联合治疗相关。
本研究表明，在中国，管理与精神分裂症相关的激越时，单药治疗和联合用药同样常见。激越的程度和行为活动以及其他一些因素与联合用药有关。
