预测居家老年抑郁症患者中枢神经系统活性药物使用和多种药物治疗的因素。
Predictors of CNS-Active Medication Use and Polypharmacy Among Homebound Older Adults With Depression.
机构信息
Steve Hicks School of Social Work, University of Texas at Austin, Austin (Choi, Marti); Behavioral Health and Implementation Program, U.S. Department of Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston (Kunik); Department of Psychiatry, Baylor College of Medicine, Houston (Kunik).
出版信息
Psychiatr Serv. 2020 Aug 1;71(8):847-850. doi: 10.1176/appi.ps.201900551. Epub 2020 Apr 28.
OBJECTIVE
The authors assessed central nervous system (CNS) polypharmacy among low-income, racially diverse homebound older adults with depression (N=277) and its associations with the participants' ratings of depressive symptoms and pain.
METHODS
CNS-active and other psychotropic and analgesic medications intake was collected from patients' medication containers. Depressive symptoms were assessed with the 24-item Hamilton Depression Rating Scale, and pain intensity was measured on an 11-point numerical rating scale. Covariates were disability (World Health Organization Disability Assessment Schedule 2.0) and perceived social support (Multidimensional Scale of Perceived Social Support).
RESULTS
Of the patients, 16% engaged in CNS polypharmacy, taking three or more CNS-active medications. Of these, 69%, 69%, and 89% were using selective serotonin reuptake inhibitors, benzodiazepines, and opioids, respectively. Higher pain intensity ratings were associated with CNS polypharmacy. Benzodiazepine users were more likely than nonusers to use opioids.
CONCLUSIONS
Medication reviews and improved access to evidence-based psychotherapeutic treatments are needed for these older individuals with depression.
目的
作者评估了低收入、种族多样化的居家老年抑郁症患者（N=277）的中枢神经系统（CNS）多种药物治疗情况，并分析其与患者抑郁症状和疼痛评分的相关性。
方法
从患者的药瓶中收集 CNS 活性药物和其他精神药物及镇痛药的使用情况。使用 24 项汉密尔顿抑郁评定量表评估抑郁症状，使用 11 点数字评分量表评估疼痛强度。协变量包括残疾（世界卫生组织残疾评估表 2.0）和感知社会支持（多维感知社会支持量表）。
结果
16%的患者接受了 CNS 多种药物治疗，即服用三种或更多种 CNS 活性药物。其中，分别有 69%、69%和 89%的患者在使用选择性 5-羟色胺再摄取抑制剂、苯二氮䓬类药物和阿片类药物。更高的疼痛强度评分与 CNS 多种药物治疗相关。与非使用者相比，苯二氮䓬类药物使用者更有可能使用阿片类药物。
结论
对于这些患有抑郁症的老年患者，需要进行药物审查并改善获得循证心理治疗的途径。
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