双相障碍不同首选用药间处方方式、不良反应、经济负担、依从性比较

The comparison of prescription pattern,adverse events,economic burden and drug-use adherence between the different preferred drug in bipolar disorder

目的比较首选心境稳定剂和首选抗精神病药治疗的双相障碍患者处方方式、不良反应、经济负担及药物治疗依从性等。方法对河北省11个地市39家精神卫生机构中接受心境稳定剂或抗精神病药治疗的240例双相障碍患者,采用自制调查问卷、临床总体印象病情严重程度量表(clinical global impressions scale-severity of illness,CGI-SI)、不良反应量表(treatment emergent symptom scale,TESS)、药物依从性评定量表(medication adherence rating scale,MARS)进行社会人口学、疾病临床特征、处方方式(联合用药情况)、精神类药物花费、不良反应及治疗依从性等方面的调查。结果首选抗精神病药治疗者(抗精神病药组)152例(63.3%),首选心境稳定剂治疗者(心境稳定剂组)88例(36.7%)。抗精神病药组与心境稳定剂组相比,住院患者构成比(90.1%vs.76.1%)、伴有精神病性症状患者构成比(27.0%vs.11.4%)、不良反应发生率(46.1%vs.31.8%)、精神类药物日花费(中位数12.00元vs.8.37元)和总花费(中位数344.61元vs.144.64元)均较高(P<0.05)。但两组间药物处方方式、不良反应严重程度、MARS总分无统计学差异(P>0.05)。结论河北省双相障碍患者以首选抗精神病药治疗为主,但首选抗精神病药并未减少之后的联合用药,且不良反应发生率及药物经济负担均明显高于首选心境稳定剂治疗者,所以心境稳定剂仍应作为双相障碍主要首选用药。

Objective To compare the differences of prescription pattern, adverse events, economic burden and drug-use adherence between preferred mood stabilizers and preferred antipsychoties in patients with bipolar disorder. Methods We investigated 240 cases of patients with bipolar disorder from 39 mental health institutions in 11 cities in Hebei province. The self-made questionnaire was used to investigate the demographic information, disease characteristics, prescription pattern and medical expense. The clinical global impression scale-severity of illness （CGI-SI） was used to assess the disease severity. The treatment emergent symptom scale （TESS） was used to assess the adverse drug reactions. The medication adherence rating scale （MARS） was used to assess drug therapy compliance in patients. Results One hundred fifty-two patients （63.3%） used antipsychotics as the first choice （antipsychotics group）, 88 patients （36.7%） used mood stabilizers as the first choice （mood stabilizers group）. The number of patients in-patient （90.1% vs. 76.1%）, patients with psychotic symptom （27.0% vs. 11.4%）, incidences of adverse events （46.1% vs. 31.8%）, drug daily cost （medians 12.00 yuan vs. 8.37 yuan） and drug total cost （medians 344.61 yuan vs. 144.64 yuan） were larger in antipsychotics group than in mood stabilizers group （P〈0.05）. There was no significant difference between two groups in pattern of prescription, severity of adverse events and total scores of MARS （P〉0.05）. Conclusion The bipolar disorder patients more frequently use antipsyehoties as the first choice in Hebei province. The use of antipsyehoties does not alter the combination medication pattern. In addition, antipsyehotics cause a higher incidence of adverse events and heavier economic burden compared with mood stabilizers, suggesting that mood stabilizers should be the first choice to bipolar disorder.