Atypical antipsychotics and parkinsonism
Atypical antipsychotics and parkinsonism
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DOI：
10.1001/archinte.165.16.1882
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发表时间：
2005-09-12
影响因子：
--
通讯作者：
Gurwitz, JH
中科院分区：
文献类型：
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作者：
Rochon, PA;Stukel, TA;Gurwitz, JH
背景：非典型抗精神病药物被认为比较老的典型药物更不可能产生帕金森综合征。这一点没有得到很好的记录。我们比较了事件帕金森氏症的发展中老年人分发非典型相对于典型antipsychotics.Methods的风险：回顾性队列研究的所有成年人66岁及以上的安大略。我们使用考克斯比例风险模型来研究之间的关联的类型，效力和剂量的抗精神病药分发和帕金森氏症的发展在1年的follow-up.Results：所有25 769老年人处方抗精神病药观察11573人年，和449事件的帕金森氏症被确定。相对于分发非典型抗精神病药的个体，分发典型药物的个体发生帕金森综合征的可能性高30%（校正风险比[HR]，1.30; 95%置信区间[CI]，1.04-1.58），暴露于两种药物的个体发生帕金森综合征的可能性低60%（HR，0.40; 95% CI，0.29-0.43）。此外，与非典型抗精神病药物相比，那些分发低效价典型药物的患者没有差异（HR，0.75; 95% CI，0.48-1.15），而那些分发高效价典型抗精神病药物的患者发生帕金森综合征的风险高出近50%（HR，1.44; 95% CI，1.13-1.84）。相对于高剂量非典型抗精神病药的患者，典型抗精神病药的患者发生帕金森综合征的风险相似（Wald x（2）= 0.14，P= 0.7）。结论：与使用高剂量非典型抗精神病药相关的帕金森综合征发生风险与使用典型抗精神病药相关的风险相似。当处方高剂量的非典型抗精神病药物治疗时应谨慎。
Background: Atypical antipsychotic agents are thought to be less likely than older typical agents to produce parkinsonism. This has not been well documented. We compared the risk of development of incident parkinsonism among older adults dispensed atypical relative to typical antipsychotics.Methods: Retrospective cohort study of all adults 66 years and older in Ontario. We used Cox proportional hazards models to study the association between the type, potency, and dose of antipsychotic dispensed and the development of parkinsonism during 1 year of follow-up.Results: All 25 769 older adults prescribed antipsychotics were observed for 11573 person-years, and 449 events of parkinsonism were identified. Relative to individuals dispensed an atypical antipsychotic, those dispensed a typical agent were 30% more likely (adjusted hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.04-1.58) and those exposed to neither agent were 60% less likely (HR, 0.40; 95% CI, 0.29-0.43) to experience development of parkinsonism. Furthermore, those dispensed lower-potency typical agents were no different (HR, 0.75; 95% CI, 0.48-1.15), and those dispensed higher-potency typical antipsychotics were at close to a 50% greater risk (HR, 1.44; 95% CI, 1.13-1.84) of development of parkinsonism relative to atypical antipsychotics. Relative to those dispensed a high-dose atypical antipsychotic, those dispensed a typical antipsychotic were at similar risk for parkinsonism (Wald x(2) = 0.14, P=.7).Conclusions: The risk of development of parkinsonism associated with the use of high-dose atypical antipsychotics was similar to that associated with the use of typical antipsychotics. Caution should be used when prescribing atypical antipsychotic therapy at high doses.