精神专科儿童青少年患者抗精神病药物的用药分析研究

Analysis of antipsychotic drug use in children and adolescent in psychiatric department

目的探讨精神专科儿童青少年患者使用抗精神病药物的情况。方法分析非典型抗精神病药物的使用情况,了解儿童精神分裂症患者的药物选择、剂量范围、联合用药、药品不良反应的发生等情况。结果90例患者选择抗精神病药物(以奥氮平、利培酮、阿立哌唑和喹硫平为主)治疗。治疗前后BPRS评定及分量表比较,临床疗效根据BPRS减分率判定,患者出院时临床显效24例(26.7%),有效49例(54.4%),无效17例(18.9%)。住院期间,联合或换用精神科药物品种数≥3种的有64例(占71.1%)。出院时单用抗精神病药者34例(占37.78%),2种抗精神病药联用者38例(占42.22%),3种抗精神病药联用者7例(占7.78%)。治疗期间,奥氮平和喹硫平的最大剂量超出欧盟批准的抗精神病药最大剂量(成人),奥氮平、利培酮和阿立哌唑的最大剂量超出NICE推荐的儿童青少年精神病治疗的最大剂量范围。药物不良反应主要以锥体外系反应(14.15%)、垂体泌乳素升高和闭经(10.85%)、心电图异常(8.02%)、便秘(5.19%)、肝功能异常(4.25%)为主。不良反应发生率较高的是利培酮(在利培酮组中占76.09%)、奥氮平(在利培酮组中占50.85%);喹硫平和阿立哌唑组不良反应发生率较低。结论非典型抗精神病药物对儿童青少年精神分裂症的阳性和阴性症状均有效。在治疗过程中,尤其是大剂量治疗时,监测体重、代谢、内分泌等相关指标的变化,通过血药浓度、药物基因检测结果来综合评估,确定或调整抗精神病药物的剂量。尽量单一用药、缓慢加量,避免不良反应的发生,提高患者用药依从性。

Objective To investigate the use of antipsychotic drugs in children and adolescents in department of psychiatry. Methods The situation of atypical antipsychotic drug use was analyzed, and the drug selection,dosage range, combined drugs and adverse drug reactions in children and adolescents with schizophrenia was acknowledged. Results The main antipsychotic drugs used by 90 patients were olanzapine, risperidone,aripiprazole and quetiapine. The clinical efficacy was judged by the reduction rate of BPRS, and the results of the comparison of BPRS and its subscale before and after treatment showed that there were 24 cases ( 26. 7%) of excellent effectiveness,49 cases ( 54. 4%) of effectiveness and 17 cases ( 18. 9%) of ineffectiveness. During hospitalization, 64 cases ( 71. 1%) used more than or equal to 3 types of psychiatric drugs. At discharge, 34 cases ( 37. 78%) were treated with antipsychotics alone, 38 cases ( 42. 22%) with 2 antipsychotics and 7 cases ( 7. 78%) with 3 antipsychotics. During treatment, the maximum doses of olanzapine and quetiapine exceeded the maximum doses of antipsychotics approved by the European Union ( adults), and the maximum doses of olanzapine, risperidone and aripiprazole exceeded the maximum doses recommended by NICE for psychiatric treatment of children and adolescents. The main adverse drug reactions were extrapyramidal reaction ( 14. 15%),hyperprolactinemia and menostasis ( 10. 85%), abnormal electrocardiogram ( 8. 02%), constipation ( 5. 19%) and abnormal liver function ( 4. 25%). The incidence rates of adverse reactions of risperidone ( 76. 09% in risperidone group) and olanzapine ( 50. 85% in risperidone group) were higher,while they were lower in quetiapine group and aripiprazole group. Conclusion Atypical antipsychotics are effective in both positive and negative symptoms of schizophrenia in children and adolescents. In the course of treatment,especially in high-dose treatment, the changes of body weight,metabolism, endocrine and other related indicators should be monitored, and the dosage of antipsychotic drugs should be determined or adjusted according to the comprehensive evaluation of drug serum concentration and pharmacogenomic results. The adverse reactions may be avoided by single drug use and slow titration, then the patients' compliance can be improved.