抗精神病药物在老年精神病患者中合理应用的调查与研究

Investigation and Research of Reasonable Application of Antipsychotics in Elderly Patients with Psychosis

目的探讨抗精神病药物在老年精神病患者中的合理应用情况。方法回顾性分析2010年1月至2012年12月吴江市第一人民医院收治的老年精神病患者的电子处方,统计抗焦虑及抗抑郁药物的使用种类、联合用药情况,并对三年间的上述情况进行比较,总结老年精神病患者使用抗精神病药物的临床特点。结果 2010年老年患者中使用5-羟色胺再摄取抑制剂(SSRIs)和三环类抗抑郁药(TCAs)的处方1445张、2011年1565张、2012年1774张;三年中SSRIs具有较高的处方频率,且2011年较2010年升高显著(P<0.05),2012年较2011年升高不显著(P>0.05);而TCAs具有较低的处方频率,且2011年较2010年降低显著(P<0.05),2012年较2011年降低不显著(P>0.05)。联合用药中联用一种及以上用药的百分率逐年下降。在与SSRIs联用的药物中以镇静催眠药物频率最高,其次是脑功能激活药和钙离子拮抗药。三年中氟西汀用量较大,超过规定剂量,其他抗焦虑及抑郁药使用合理。结论对老年精神病患者实施抗精神病药物合理治疗应根据患者的具体病情结合药物的特点和医师经验进行综合分析和考虑,达到真正的抗精神病药物的合理应用。

Objective To explore reasonable application of antipsychotics in elderly patients with psy- chosis. Methods Electronic prescription for elderly psychiatric patients admitted by Wujiang First People＇s Hospital from Jan. 2010 to Dee. 2012 were analyzed retrospectively, anxiolytic and antidepressant use types, combined use of drugs, and the situation during the three years were compared, and the clinical features of usage antipsychotic drugs in elderly psychiatric patients were summarized. Results In year 2010 elderly patients using a 5-serotouin reuptake inhibitors （ SSRIs ） and tricyclic antidepressants （ TCAs ） prescription 1445, in year 2011 1565, in year 2012 1774 ;years, SSRIs had a high frequency of prescription,2011 signifi- cantly higher then 2010（P 〈0. 05） ,2012 higher then 2011 but not significantly（P 〉 0.05o） ; TCAs had a lower frequency of prescription,2011 significantly lower then 2010（ P 〈0.05 ） ,2012 lower then 2011 but not siguificantly（P 〉 0.05 ）. Combined medication percentage was declining. Most frequently SSRIs associated drugs were sedative-hypnotic drugs, followed by brain function activators and calcium antagonists. Fluoxetine usage during the three years was larger, exceeding the prescribed dose, while usage of other anti-anxiety and depression medication was rational. Conclusion The antipsychotic treatment of elderly psychiatric patients should be based on comprehensive analysis and considerations of the patient＇s specific health condition char- acteristic combining with drug characteristics and clinicians＇ experience to achieve real reasonable application of antipsvchotics.