Adachi Mental Clinic, Sapporo, Japan.
Shioiri Mental Clinic, Yokosuka, Japan.
Hum Psychopharmacol. 2021 Mar;36(2):e2764. doi: 10.1002/hup.2764. Epub 2020 Oct 22.
This study aims to clarify the relevant factors influencing practitioners' methods of prescribing medications for bipolar disorder, in a nation-wide survey in Japan.
The clinical records of 3130 outpatients with bipolar disorder were consecutively reviewed from 176 psychiatric outpatient clinics. Fifteen parameters, that is, five patients' including five general characteristics (sex, age, education, occupation, and social adjustment), five patients' aspects of mental functioning (onset age, comorbid mental illness, rapid-cycling, psychopathologic severity, and followed-up years), and five practitioners' characteristics (sex, age, specialist experience, clinic standing years, and location), were evaluated. The number of psychotropic drugs (mood stabilizers, antidepressants, antipsychotic drugs, anxiolytics, and hypnotics) was used as an index of pharmacotherapy. Converted data from each practitioner-unit were analyzed.
Seven factors (patient's social adjustment, patient's psychopathology, patient's comorbid mental disorders, patient's followed-up years, doctor's age, clinic running years, and patient's education years) were correlated to the number of psychotropic drugs. Multiple regression analysis showed that the severity of illness (poor social adjustment, and comorbid mental illness) and an intractable disease course (long followed-up years), were significantly associated with the number of psychotropic drugs.
Our findings indicated that patient-related conditions affected psychotropic polypharmacy more strongly than did practitioner-related conditions.
本研究旨在通过日本全国性调查，阐明影响双相障碍患者药物治疗方法的相关因素。
连续查阅了 176 家精神科门诊 3130 例双相障碍门诊患者的临床记录。评估了 15 个参数，即 5 个患者的一般特征（性别、年龄、教育、职业和社会适应）、5 个患者的精神功能状况（发病年龄、共患精神疾病、快速循环、精神病理严重程度和随访年限）和 5 个医生的特征（性别、年龄、专科经验、诊所开设年限和地点）。将精神药物（心境稳定剂、抗抑郁药、抗精神病药、抗焦虑药和催眠药）的数量用作药物治疗的指标。对每个医生单位的转换数据进行了分析。
有 7 个因素（患者的社会适应、患者的精神病理、患者的共患精神疾病、患者的随访年限、医生的年龄、诊所开设年限和患者的受教育年限）与精神药物的数量相关。多因素回归分析显示，疾病的严重程度（社会适应不良和共患精神疾病）和难治性病程（随访年限长）与精神药物的数量显著相关。
我们的研究结果表明，与医生相关的因素相比，患者相关的条件对精神药物的联合使用影响更大。
