Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns.
Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns.
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退伍军人事务部卫生系统中的长期抗精神病药物多药治疗：患者特征和治疗模式。
DOI：
10.1176/ps.2007.58.4.489
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Blow,FredericC
中科院分区：
文献类型：
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作者：
Kreyenbuhl,JulieA;Valenstein,Marcia;McCarthy,JohnF;Ganoczy,Dara;Blow,FredericC
尽管抗精神病药物的多药治疗越来越频繁，但很少有研究描述与长期使用这种治疗策略相关的患者特征和治疗模式。826例长期服用多种抗精神病药物的精神分裂症或情感障碍患者（同时使用两种或两种以上抗精神病药物治疗90天或更长时间），确定了39，745例接受长期抗精神病药物单药治疗的患者。通过使用多变量回归模型，患者的人口统计学和临床特征，抗精神病药物剂量，并使用抗帕金森病药和抗精神病药物进行了比较两组之间。ResultsPatients更有可能接受抗精神病药物多药，如果他们年轻，未婚，有一个军事服务连接的残疾，精神分裂症，而不是情感障碍，或更多地使用住院和门诊心理健康服务。如果患者是非裔美国人，同时被诊断为抑郁症或物质使用障碍，或有更大的医疗合并症，则不太可能接受抗精神病药物多药治疗。对于大多数抗精神病药物，接受多种药物治疗的患者的处方剂量与接受单药治疗的患者的处方剂量相同或略高。多药处方的患者更有可能接受抗帕金森病药物，抗焦虑药，情绪稳定剂和同样可能接受并发治疗与抗抑郁药conclusionsLongterm抗精神病药物多药似乎是保留为更严重的精神病症状，而不是情绪症状的患者。这些患者可能会因为过量的抗精神病药物暴露而增加不良反应。（精神病学服务58：489-495，2007）
ObjectiveAlthough antipsychotic polypharmacy is being prescribed with increasing frequency, few studies have described patient characteristics and treatment patterns associated with long-term use of this treatment strategy.MethodsBy using data from the National Psychosis Registry of the Department of Veterans Affairs, 5,826 patients with schizophrenia or schizoaffective disorder who received long-term antipsychotic polypharmacy (simultaneous treatment with two or more antipsychotics for 90 or more days) during fiscal year 2000 and 39,745 patients who received longterm antipsychotic monotherapy were identified. By using multivariate regression models, patient demographic and clinical characteristics, antipsychotic dosages, and use of antiparkinson and adjunctive psychotropic medications were compared between the two groups.ResultsPatients were more likely to receive antipsychotic polypharmacy if they were younger, were unmarried, had a military service–connected disability, had schizophrenia rather than schizoaffective disorder, or had greater use of inpatient and outpatient mental health services. Patients were less likely to receive antipsychotic polypharmacy if they were African American, had concurrent diagnoses of depression or substance use disorder, or had greater medical comorbidity. For most antipsychotics, dosages prescribed for patients receiving polypharmacy were the same or modestly higher than those prescribed for patients receiving monotherapy. Patients given prescriptions for polypharmacy were more likely to receive antiparkinson medications, antianxiety agents, and mood stabilizers and equally likely to receive concurrent treatment with antidepressants.ConclusionsLongterm antipsychotic polypharmacy appears to be reserved for more severely ill patients with psychotic symptoms rather than mood symptoms. These patients may experience increased adverse effects as a result of excess antipsychotic exposure.(Psychiatric Services 58: 489–495, 2007)