Vadiei Nina, Chien Jonathan, Enwereji Jude, Myslinski Britt, Guzman Alexander
Assistant Professor, University of Arizona College of Pharmacy, Tucson, Arizona; Assistant Professor, University of Arizona College of Medicine, Tucson, Arizona,
Student, University of Arizona College of Pharmacy, Tucson, Arizona.
Ment Health Clin. 2020 Sep 30;10(5):275-281. doi: 10.9740/mhc.2020.09.275. eCollection 2020 Sep.
Antipsychotics are commonly used to treat psychotic symptoms and severe mental illnesses. Treatment guidelines recommend antipsychotics be titrated quickly to therapeutic effect in the acute setting but acknowledge that determining the optimal dose is complicated by a delay between treatment initiation and therapeutic response. The purpose of this study was to evaluate antipsychotic titration patterns in an inpatient psychiatric hospital.
This study is a retrospective chart review of adult patients admitted to a teaching hospital and initiated on an antipsychotic for treatment of psychosis between January and December 2018. Patients were excluded if they had substance-induced psychosis, delirium, were prescribed >1 antipsychotic, or had no antipsychotic dose changes. The primary outcome was the average titration rate of the newly initiated antipsychotic. Secondary outcomes included differences in titration rate between involuntary and voluntary admissions and other antipsychotic characteristics.
Of 149 patients included, the majority had a primary diagnosis of schizophrenia. Antipsychotics were titrated on average every 2 days regardless of admission type. Eighteen percent of patients were titrated to guideline-recommended maximum doses, and it took, on average, 3 days for patients to reach their final dose during hospitalization. Average length of stay was 9 days, and 43.6% of patients were readmitted within 1 year.
Antipsychotics are titrated rapidly in the inpatient setting despite a lack of evidence regarding the impact of titration rate on clinical outcomes. Further studies comparing slow versus rapid titration strategies are needed to elucidate the impact of this on patient outcomes.
抗精神病药物常用于治疗精神病性症状和严重精神疾病。治疗指南建议在急性情况下迅速滴定抗精神病药物至治疗效果，但也承认确定最佳剂量因治疗开始与治疗反应之间的延迟而变得复杂。本研究的目的是评估一家住院精神病医院的抗精神病药物滴定模式。
本研究是对2018年1月至12月期间入住一家教学医院并开始使用抗精神病药物治疗精神病的成年患者进行的回顾性病历审查。如果患者患有物质所致精神病、谵妄、被处方使用超过1种抗精神病药物或抗精神病药物剂量无变化，则将其排除。主要结局是新开始使用的抗精神病药物的平均滴定率。次要结局包括非自愿入院和自愿入院之间滴定率的差异以及其他抗精神病药物特征。
纳入的149例患者中，大多数的主要诊断为精神分裂症。无论入院类型如何，抗精神病药物平均每2天滴定一次。18%的患者被滴定至指南推荐的最大剂量，住院期间患者平均需要3天达到最终剂量。平均住院时间为9天，43.6%的患者在1年内再次入院。
尽管缺乏关于滴定率对临床结局影响的证据，但在住院环境中抗精神病药物滴定迅速。需要进一步比较缓慢滴定与快速滴定策略的研究，以阐明其对患者结局的影响。
