Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Psychogeriatrics. 2024 Nov;24(6):1324-1334. doi: 10.1111/psyg.13197. Epub 2024 Sep 29.
Older-age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. There have been no studies to examine temporal trends in the pharmacological treatment of OABD. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019.
OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilisers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics (SGAs and FGAs)), and antidepressants, were investigated. Complex polypharmacy was defined as the use of three or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test.
The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilisers, and complex polypharmacy significantly increased over time, whereas the prescription rates of mood stabilisers, lithium, FGAs, and antidepressants plus mood stabilisers significantly decreased.
Prescribing patterns changed remarkably for OABD patients over a 14-year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.
老年双相障碍（OABD）通常定义为 60 岁及以上个体的双相障碍。目前尚无研究探讨 OABD 的药物治疗随时间的变化趋势。我们旨在调查台湾两家公立精神病院 2006 年至 2019 年期间出院的 OABD 患者的处方变化情况。
分析了自 2006 年 1 月 1 日至 2019 年 12 月 31 日从两家研究医院出院的 OABD 患者（n=1072）。研究了出院时开具的药物，包括心境稳定剂（即锂、丙戊酸盐、卡马西平和拉莫三嗪）、抗精神病药（即第二代和第一代抗精神病药（SGAs 和 FGAs））和抗抑郁药。复杂联合用药定义为使用规定药物中三种或更多种药物。使用 Cochran-Armitage 趋势检验分析每种用药模式的时间趋势。
最常开具的药物是 SGAs（72.0%），其次是丙戊酸盐（48.4%）和抗抑郁药（21.7%）。SGAs、抗抑郁药、无心境稳定剂的抗抑郁药和复杂联合用药的处方率随时间显著增加，而心境稳定剂、锂、FGAs 和抗抑郁药加心境稳定剂的处方率显著降低。
在 14 年期间，OABD 患者的用药模式发生了显著变化。锂的使用减少和抗抑郁药的使用增加并没有反映出双相障碍的治疗指南。未来的研究应该检查这种用药模式是否与不良临床结果有关。
