Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of General Psychiatry, Taoyuan Psychiatric Center, No. 71, Long-Show Street, Taoyuan 33058, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
Eur Neuropsychopharmacol. 2021 Feb;43:139-146. doi: 10.1016/j.euroneuro.2020.12.008. Epub 2021 Jan 6.
The aim of this study was to investigate factors associated with concomitant laxative use among schizophrenia patients discharged on second-generation antipsychotics (SGAs) at two large psychiatric hospitals in Taiwan. Patients with schizophrenia who were discharged between 2006 and 2017 and received SGA monotherapy at discharge were included in the analysis. Multivariate logistic regression was used to identify factors associated with regular laxative use at discharge. Multivariate Cox regression was used to determine the effect of laxative use at discharge on time to rehospitalization within one year. The Cochran-Armitage trend test was used to evaluate whether significant time trends existed for rates of laxative use at discharge during the study period. Among patients discharged on SGAs (n = 11,861), 3,336 (28.1%) also received concomitant laxatives. Advanced age and higher antipsychotic or anticholinergic doses were found to be associated with an increase in laxative use. Among SGAs, clozapine was associated with the highest rate of laxative use, followed by zotepine, quetiapine, olanzapine and risperidone. Additionally, risperidone, amisulpride, aripiprazole, paliperidone and ziprasidone were associated with comparable rates of laxative use. In contrast, sulpiride was least associated with laxative use among all SGAs. Regular laxative use at discharge was found to be significantly associated with psychiatric rehospitalization. Also, rate of laxative use at discharge increased significantly during the study period. Laxative use is common in schizophrenia patients treated with SGAs. For clinically significant constipation, switching to an SGA with a lower risk for constipation, and decreasing the doses of SGAs and anticholinergics should be considered.
本研究旨在探讨台湾两家大型精神科医院出院的第二代抗精神病药物（SGAs）治疗的精神分裂症患者同时使用泻药的相关因素。纳入分析的患者为 2006 年至 2017 年期间出院、出院时接受 SGA 单药治疗的精神分裂症患者。采用多变量逻辑回归分析确定与出院时常规使用泻药相关的因素。采用多变量 Cox 回归分析确定出院时使用泻药对一年内再入院时间的影响。采用 Cochran-Armitage 趋势检验评估研究期间出院时使用泻药的比率是否存在显著时间趋势。在出院接受 SGA 治疗的患者（n=11861）中，有 3336 例（28.1%）同时接受了伴随性泻药。研究发现，年龄较大和抗精神病药物或抗胆碱能药物剂量较高与泻药使用增加相关。在 SGA 中，氯氮平与泻药使用的比率最高，其次是佐替平、喹硫平、奥氮平和利培酮。此外，利培酮、氨磺必利、阿立哌唑、帕利哌酮和齐拉西酮与类似的泻药使用比率相关。相比之下，所有 SGA 中，舒必利与泻药使用的关联最小。出院时常规使用泻药与精神科再入院显著相关。此外，在研究期间，出院时使用泻药的比率显著增加。在接受 SGA 治疗的精神分裂症患者中，经常使用泻药。对于临床上明显的便秘，应考虑改用便秘风险较低的 SGA，并减少 SGA 和抗胆碱能药物的剂量。
