Factors associated with antipsychotic dosing in psychiatric inpatients:: a prospective study
Factors associated with antipsychotic dosing in psychiatric inpatients:: a prospective study
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DOI：
10.1097/yic.0b013e3281084ea8
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发表时间：
2007-07-01
影响因子：
2.6
通讯作者：
Grassi, Luigi
中科院分区：
文献类型：
--
作者：
Barbui, Corrado;Biancosino, Bruno;Grassi, Luigi
持续使用超过推荐水平的剂量与不良反应风险增加相关，没有额外获益的证据。在住院精神病患者中对这种治疗方式进行了评价。在为期6年的招募期内，纳入了一系列连续的接受抗精神病药物治疗的精神病住院患者。在入院时，收集社会人口统计学和临床数据，包括抗精神病药物的使用，并进行18项版本的简明精神病评定量表。在出院时，收集抗精神病药物治疗的数据。将处方日剂量转换为规定日剂量的倍数。在入院和出院评估时，使用处方日剂量/规定日剂量的截止评分（比值均大于1.5），共有62例（15.4%）患者持续接受高抗精神病药物剂量。然而，在不太严格的标准下（处方日剂量/规定日剂量的比率大于2），整个样本中只有4.4%持续暴露于高抗精神病药物剂量。自举线性回归分析显示阳性症状与高剂量抗精神病药物呈正相关，而阴性症状与高剂量抗精神病药物呈负相关。入院时服用多种抗精神病药物是持续接受超过推荐剂量的抗精神病药物的最强预测因子。这项研究表明，使用高剂量的抗精神病药物不是偶然事件。临床医生应考虑同时使用两种或两种以上抗精神病药物会增加长期过量给药的可能性。
The persistent use of doses in excess of recommended levels is associated with increased risks of adverse reactions without evidence of additional benefits. Such treatment modality was evaluated in hospitalized psychiatric patients. During a 6-year recruitment period, a consecutive series of psychiatric inpatients receiving antipsychotic therapy were included. At admission, sociodemographic and clinical data, including antipsychotic drug use, were collected, and the 18-item version of the Brief Psychiatric Rating Scale was administered. At discharge, data on antipsychotic drug therapy were collected. Prescribed daily doses were converted into multiples of the defined daily doses. Using a cut-off score of a prescribed daily dose/defined daily dose as a ratio of more than 1.5 both at admission and at discharge assessments, a total of 62 (15.4%) patients persistently received high antipsychotic dose. With less stringent criteria (prescribed daily dose/defined daily dose as a ratio of more than 2), however, only 4.4% of the entire sample was persistently exposed to high antipsychotic doses. Bootstrapped linear regression analysis revealed that positive symptoms were positively associated with high antipsychotic dose, whereas negative symptoms were negatively associated with high antipsychotic dose. Antipsychotic polypharmacy at admission was the strongest predictor of persistently receiving antipsychotic doses in excess of recommended levels. This study showed that the use of high antipsychotic dosing is not an occasional event. Clinicians should consider that concurrent prescribing of two or more antipsychotic agents increases the probability of administering excessive dosing in the long-term.