Department of Psychiatry, Taoyuan Psychiatric Centre, Taoyuan, Taiwan.
Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan.
Psychogeriatrics. 2020 Jul;20(4):447-457. doi: 10.1111/psyg.12527. Epub 2020 Feb 7.
It has been emphasised that benzodiazepines and related drugs (BZDRs) should be used cautiously in people with dementia. The aim of this study was to identify factors associated with inappropriate prescription patterns of BZDRs including polypharmacy, long-term treatment and high doses among patients with dementia taking BZDRs.
This was a retrospective chart review study of patients with dementia who were treated at the study hospital. The date that the patient was issued a catastrophic illness certificate from the National Health Insurance Administration was used as the index date. Medical records of the 2-year period after the index date were reviewed.
A total of 308 patients with dementia were included in this study. Among them, 151 (49.0%) received at least one prescription of BZDRs. After adjusting for covariates, psychiatric comorbidities (adjusted odds ratio (aOR) = 4.74, 95% CI = 1.75-12.81), history of past suicidal behaviour (aOR = 4.25, 95% CI = 1.40-12.88) and long-term treatment with BZDRs (aOR = 3.38, 95% CI = 1.11-10.27) were associated with polypharmacy of BZDRs. Age (aOR = 1.05, 95% CI = 1.0-1.11) and polypharmacy (aOR = 3.57, 95% CI = 1.23-10.32) were associated with long-term treatment. Living with family (aOR = 3.33, 95% CI = 1.32-9.79) and fewer psychiatric admissions to the study hospital (aOR = 0.56, 95% CI = 0.36-0.86) were associated with treatment with high doses of BZDRs.
Treatment with BZDRs is prevalent in patients with dementia. Inappropriate prescription patterns of BZDRs are not uncommon in these patients and may be interlinked.
已强调指出，苯二氮䓬类药物和相关药物（BZDRs）在痴呆患者中应谨慎使用。本研究的目的是确定与 BZDR 不合理处方模式相关的因素，包括痴呆患者 BZDR 联合用药、长期治疗和高剂量。
这是一项回顾性图表审查研究，纳入在研究医院接受治疗的痴呆患者。以患者从国家健康保险管理局获得重大疾病证书的日期作为索引日期。审查索引日期后 2 年的病历记录。
本研究共纳入 308 例痴呆患者。其中，151 例（49.0%）至少接受过一次 BZDR 处方。在调整了混杂因素后，精神共病（调整后的优势比（aOR）=4.74，95%置信区间（CI）=1.75-12.81）、既往自杀行为史（aOR=4.25，95%CI=1.40-12.88）和 BZDR 长期治疗（aOR=3.38，95%CI=1.11-10.27）与 BZDR 联合用药相关。年龄（aOR=1.05，95%CI=1.0-1.11）和联合用药（aOR=3.57，95%CI=1.23-10.32）与长期治疗相关。与家人同住（aOR=3.33，95%CI=1.32-9.79）和较少到研究医院进行精神科就诊（aOR=0.56，95%CI=0.36-0.86）与 BZDR 高剂量治疗相关。
BZDR 治疗在痴呆患者中普遍存在。这些患者中 BZDR 不合理处方模式并不少见，且可能相互关联。
