Competency Center for Dual Diagnosis, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
Institute for Clinical Mediine, University of Copenhagen, Copenhagen, Denmark.
Nord J Psychiatry. 2024 Feb;78(2):112-119. doi: 10.1080/08039488.2023.2277820. Epub 2024 Jan 31.
Antipsychotic polypharmacy is prevalent, however literature on antipsychotic polypharmacy during treatment among patients with dual diagnosis is largely non-existent. This study aims to investigating the extent of antipsychotic polypharmacy dual diagnosis patients during hospitalisations.
Utilizing cohort data from an integrated dual diagnosis in-patient facility from patients hospitalized between 1 March 2012, to 31 December 2016, we compared the mean antipsychotic medication administered at admission and discharge and examined covariate associations with logistic regressions.
The study identified 907 hospital admissions, of which 641 were the first for each patient during the period. At admission, 74.1% received antipsychotics; polypharmacy spanned psychiatric disorders. categories. Patients with affective or personality spectrum disorders were less likely to have antipsychotic polypharmacy upon admission compared to those with psychosis spectrum disorders. 2013-2016 admissions presented less polypharmacy than 2012. Mean antipsychotic numbers remained unchanged for >30-day hospitalizations. Patients admitted without antipsychotic polypharmacy with an affective spectrum disorder or aged 41-50 or over 51 years old were less likely to be discharged with antipsychotic polypharmacy when compared to patients with psychosis spectrum disorder or aged 18-30 years old.
Approximately three-quarters of admitted patients were treated with antipsychotic medication. Antipsychotic polypharmacy was observed across all psychiatric disorder categories, indicating potential off-label use. Addressing antipsychotic polypharmacy during treatment is challenging, even for specialised facilities. Rational antipsychotic prescribing, deprescribing protocols, and further prescription pattern research are needed.
抗精神病药的联合用药较为普遍，但针对双相障碍患者在治疗过程中的抗精神病药联合用药的文献却很少。本研究旨在调查住院期间双相障碍患者的抗精神病药联合用药的程度。
利用 2012 年 3 月 1 日至 2016 年 12 月 31 日期间在一家综合双相障碍住院机构住院的患者队列数据，我们比较了入院和出院时平均给予的抗精神病药物，并使用逻辑回归分析了协变量的关联。
研究共纳入了 907 例住院病例，其中 641 例为每位患者在该期间的首次住院。入院时，74.1%的患者接受了抗精神病药物治疗；联合用药涵盖了精神障碍的各个类别。与精神病谱障碍患者相比，情感或人格障碍谱患者入院时抗精神病药联合用药的可能性较小。2013-2016 年入院患者的联合用药比例低于 2012 年。对于住院时间超过 30 天的患者，抗精神病药物的数量保持不变。与精神病谱障碍患者相比，入院时未使用抗精神病药联合用药且患有情感障碍谱或年龄在 41-50 岁或 51 岁以上的患者，出院时使用抗精神病药联合用药的可能性较小。
大约四分之三的入院患者接受了抗精神病药物治疗。抗精神病药联合用药在所有精神障碍类别中均有观察到，表明可能存在超适应证使用。即使是在专门的医疗机构，在治疗过程中对抗精神病药联合用药的处理也具有挑战性。需要制定合理的抗精神病药物处方、减药方案，并进一步研究处方模式。
