Guangzhou Medical University, Guangzhou, China.
Department of Chronic Psychiatry, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, China.
Medicine (Baltimore). 2024 Sep 13;103(37):e39629. doi: 10.1097/MD.0000000000039629.
Schizophrenia is a severe mental disorder. However, there is limited data on the prescribing patterns of patients under China's Central Government Support for the Local Management and Treatment of Severe Mental Illnesses Program, known as the "686 program." This study aimed to investigate the use of antipsychotic medications and associated factors among discharged schizophrenia patients in Guangdong Province, within the 686 Program. This study encompassed schizophrenia patients who were discharged from the Affiliated Brain Hospital, Guangzhou Medical University and enrolled in the 686 Program between January 2019 and December 2019. A total of 1645 hospitalized schizophrenia patients were included in the analysis. Clinical and sociodemographic data were acquired from medical records upon discharge. A total of 15 unique antipsychotic medications were utilized, comprising 4 first-generation (FGAs) and 11 second-generation (SGAs) options. FGAs were prescribed at a rate of 8.3%, while SGAs dominated at 98.8%. Risperidone (40.8%), olanzapine (30.2%), clozapine (24.6%), and amisulpride (15.4%) emerged as the top 4 prescribed medications. Additionally, mood stabilizers were used by 20.4%, antidepressants by 14.8%, sedative-hypnotics by 33.6%, anticholinergics by 26.9%, and other internal medicine drugs by 46.4%. Notably, 60.5% received antipsychotic monotherapy (AMT), while 39.5% underwent antipsychotic polypharmacy (APP). Predictors of polypharmacy included multiple hospital admissions, longer hospital stays, and undergoing modified Electroconvulsive Therapy (mECT) during hospitalization. In Guangdong Province, China's 686 Program, hospitalized patients commonly receive multiple antipsychotic medications simultaneously. Due to the varying outcomes in current studies on the benefits and risks of polypharmacy, it's vital to educate psychiatrists about the importance of AMT to reduce APP. Additionally, randomized, controlled trials are essential to identify the safest and most effective antipsychotic combinations, as well as to understand which patient profiles may benefit from these combinations.
精神分裂症是一种严重的精神障碍。然而，在中国中央政府支持的地方严重精神疾病管理和治疗计划（简称“686 计划”）下，针对患者的处方模式数据有限。本研究旨在调查广东省 686 计划出院的精神分裂症患者使用抗精神病药物的情况及相关因素。该研究纳入了 2019 年 1 月至 2019 年 12 月期间从广州医科大学附属脑科医院出院并纳入 686 计划的精神分裂症患者。共纳入 1645 例住院精神分裂症患者。出院时从病历中获取临床和社会人口学数据。共使用了 15 种独特的抗精神病药物，包括 4 种第一代（FGAs）和 11 种第二代（SGAs）药物。FGAs 的处方率为 8.3%，而 SGA 则占 98.8%。利培酮（40.8%）、奥氮平（30.2%）、氯氮平（24.6%）和氨磺必利（15.4%）是前 4 种处方药物。此外，20.4%的患者使用了心境稳定剂，14.8%的患者使用了抗抑郁药，33.6%的患者使用了镇静催眠药，26.9%的患者使用了抗胆碱能药物，46.4%的患者使用了其他内科药物。值得注意的是，60.5%的患者接受了抗精神病药单药治疗（AMT），39.5%的患者接受了抗精神病药联合治疗（APP）。多住院、住院时间长、住院期间接受改良电休克治疗（mECT）是 APP 的预测因素。在中国广东省的 686 计划中，住院患者通常同时接受多种抗精神病药物治疗。鉴于目前关于多药治疗的益处和风险的研究结果不一，教育精神科医生 AMT 的重要性以减少 APP 至关重要。此外，还需要进行随机对照试验，以确定最安全有效的抗精神病药物联合治疗方案，并了解哪些患者可能受益于这些联合治疗方案。
