Psychotropic Polypharmacy in Patients with Dementia: Prevalence and Predictors
Psychotropic Polypharmacy in Patients with Dementia: Prevalence and Predictors
复制标题
DOI：
10.3233/jad-160828
复制
发表时间：
2017-01-01
影响因子：
4
通讯作者：
Waldemar, Gunhild
中科院分区：
文献类型：
--
作者：
Norgaard, Ane;Jensen-Dahm, Christina;Waldemar, Gunhild
背景资料：抗精神病药物和其他精神药物经常用于治疗痴呆患者的神经精神症状，尽管其疗效的证据有限。抗精神病药物的安全性引起了人们的关注，但同时使用多种精神药物类（精神科多药）也可能对patients.Objective：To investigate the prevalence and predictors associated with use of psychological multipharmacy in patients with dementia.Methods：A population-based study using national register. 2012年1月1日，在所有≥ 65岁的丹麦居民中确定了痴呆患者。处方和合并症数据纳入分析。不同精神药物类别的重叠处方被用来确定精神药物复方。进行多变量logistic回归分析，以评估与已经使用抗精神病药物的患者中其他精神药物类别处方独立相关的因素。结果：在所有登记的痴呆患者（34，553）中，25.3%（8，728）使用≥ 2种精神药物。在接受抗精神病药物治疗的患者中，75.8%（5，403）在抗精神病药物治疗期间至少使用了一种其他精神药物。在抗精神病药物使用者中，疗养院居住、2011年使用的非精神药物数量和既往精神病诊断与精神病药物多药治疗相关。精神药物最常见的联合用药是抗精神病药和抗抑郁药。结论：痴呆患者合并使用精神药物的情况较为常见。生活在疗养院的患者接受抗精神病药物和其他精神药物组合的风险最高。合并使用精神药物可能导致不良事件，对患者安全性的潜在后果需要进一步研究。
Background: Antipsychotics and other psychotropics are frequently used to treat neuropsychiatric symptoms in patients with dementia, even though the evidence for effect is limited. Concerns have been raised about the safety of antipsychotics, but concomitant use of multiple psychotropic drug classes (psychotropic polypharmacy) may also pose a risk for patients.Objective: To investigate the prevalence and predictors associated with use of psychotropic polypharmacy in patients with dementia.Methods: A population-based study using nationwide registers. Patients with dementia were identified among all Danish residents= 65 years on January 1, 2012. Data on prescriptions and comorbidity was included in the analysis. Overlapping prescriptions for different psychotropic drug classes were used to determine psychotropic polypharmacy. Amultivariable logistic regression analysis was conducted to evaluate factors independently associated with the prescription of other psychotropic drug classes among patients already using antipsychotics.Results: Among all patients registered with dementia (34,553), 25.3% (8,728) used = 2 psychotropic drugs. Among patients treated with antipsychotics 75.8% (5,403) used at least one other psychotropic drug during the antipsychotic treatment period. Nursing home residency, number of non-psychotropic medications used in 2011, and prior psychiatric diagnosis were associated with psychotropic polypharmacy among antipsychotic drug users. The most frequent combination of psychotropic drugs was antipsychotics and antidepressants.Conclusion: Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may cause adverse events, and potential consequences for patients' safety call for further investigation.