住院精神分裂症患者抗精神病药物联合治疗的处方调查

Prescription survey of antipsychotic polypharmacy in schizophrenia inpatients

目的了解住院精神分裂症患者抗精神病药物联合治疗(APP)的情况,为精神分裂症的临床用药提供参考。方法连续入组2014年1月1日-12月31日在广州医科大学附属脑科医院住院的精神分裂症患者,收集患者的社会人口学资料,使用临床总体印象量表-病情严重程度量表(CGI-SI)评估患者疾病严重程度,在患者出院日记录抗精神病药物的使用情况,比较接受单一抗精神病药物治疗患者(单药组)与接受APP患者(APP组)的临床特点,描述APP中具体抗精神病药物的使用情况。结果共入组801例住院精神分裂症患者,其中364例(45.4%)使用APP。与单药组相比,APP组发病年龄更小、本次住院时间和总病程更长、住院次数更多,差异均有统计学意义(P均<0.05)。APP组中78.0%的患者为同时使用两种第二代抗精神病药物(SGA),常见的联用方式为利培酮(47.3%)、氯氮平(44.5%)和奥氮平(40.1%)联合另一种抗精神病药物。结论住院精神分裂症患者中,接受APP方案的患者发病较早且病程迁延;两种SGA联用是APP中最常见的疗法,APP方案中使用频率最高的药物依次为利培酮、氯氮平和奥氮平。

Objective To investigate the use of antipsychotic polypharmacy （APP） in hospitalized patients with schizophrenia through prescription survey, and to provide reference for medication of schizophrenic therapy. Methods A continuous sample of schizophrenic inpatients was enrolled from January 1st to December 31st 2014 in the Affiliated Brain Hospital of Guangzhou Medical University. Demographic data were collected, and illness severity was assessed by Clinical Global Impression - Severity of Illness （CGI -SI）. Prescriptions of antipsychotics were recorded at the date of discharge. The clinical characteristics of patients treated with single antipsychotic drug （single drug group） and those treated with APP （APP group） were compared. Descriptive analysis was used to illustrate the specific antipsychotics application. Results 801 patients were enrolled, and 364 cases （45.4%） of them were treated with APP method. Patients of APP group showed earlier age of onset, longer hospital stays and total course, and more times of hospitalization than those in single drug group, and the differences between two groups were statistically significant （P 〈 0. 05）. In APP group, 78.0% cases accepted prescribed two kinds of second - generation antipsychoties （SGA） in combination, and the most common patterns were combination of risperidone（47.3% ）, clozapine（44.5% ） or olanzapine（40. 1% ） with another antipsychotics. Conclusion Schizophrenic inpatients treated with APP have earlier age of onset and longer duration of illness. Combination use of two SGAs is the most common method, and the most frequently used medications are risperidone, clozapine and olanzapine.