| 摘要: | 思覺失調症是屬於一種慢性、退化性而失能的腦部疾病，容易受疾病之症狀干擾而復發。抗精神病藥物之投予，成為思覺失調症主要治療方式。目前抗精神病藥物已發展至第二代，但醫師在治療思覺失調症時為增進療效、減少副作用及降低醫療成本，常併用兩代抗精神病藥物或精神藥物而有多重用藥情況。本研究是為瞭解精神科專科醫師對思覺失調症住院病患之用藥情況。 本研究採用高雄市某精神專科醫院於2009.01.01～2013.12.31年間思覺失調症之住院病患用藥電子資料檔，以回溯性分析法，針對406位住院病患之11,662次處以抗精神病藥物的處方，進行用藥之型態、劑量、劑型及合併用藥種類之描述性分析及變項分析。 結果顯示住院病患男性比女性多，女性病患平均年齡(48.07歲)比男性(46.23歲)高。該院抗精神病藥物有第一代抗精神病藥(FGAs)，第二代抗精神病藥(SGAs)及針劑。病患用藥分析結果顯示以使用SGAs之比例最高，占50.75%。為增加療效，減少副作用及降低成本，併用抗精神病藥物及精神藥物之多重用藥情況占87.68%。在抗精神病藥物中以安眠藥併用最多，抗焦慮藥次之，FGAs及SGAs併用安眠藥分別為11.94%及18.07%。 該院醫師對各抗精神病藥物之平均處方劑量分析結果，FGAs以Haloperidol最高，為1.10DDD，SGAs以Aripeprazole最高，為1.25DDD，針劑以Clopenthixol Deanoate最高，為1.05DDD。 為了減緩抗精神病藥物之錐體外症候群 (EPS) ，會合併使用抗巴金森氏症藥，分析結果，FGAs以Haloperidol併用比最高有127.27%，SGAs以Risperidone併用比最高有108.33%，為了提高治療效果，抗精神病藥物也會併用精神藥物。 本研究探討高雄市某精神專科醫院之思覺失調症住院病患抗精神病藥物用藥，以合併使用抗精神病藥物及其他精神藥物占高比例，合併藥物的原因大多為增加抗精神病之效果或是降低副作用之發生，對於精神病病患之用藥該醫院的使用並無明顯異於其他精神病院病患之使用，唯多數研究均著重於藥物使用的探究，未來之研究應著重於藥師衛教方向，以期提昇病患藥物治療之效果。關鍵字：思覺失調症、抗精神病藥物、精神藥物、處方型態
Schizophrenia is a type of chronic and degenerative brain disease. Administration of antipsychotic medication is the cornerstone treatment of Schizophrenia. Currently antipsychotics have been classified as first and second generation and injection formation. However, the combination of two generations of antipsychotics and/or antipsychotics and psychotic drugs are often observed in order to increase the efficacy, reduce side effects and cut sown health care costsThe aim of this study was to understand the medications for inpatients of schizophrenia. This study was a retrospective study. A total numbers of 406 inpatients and 11,662 prescriptions were collected from medical records of inpatients of schizophrenia from a psychiatric hospital in Kaohsiung city between January 1, 2009 and December 31, 2013. The types of antipsychotics, dosage and types of combination medication were investigated by descriptive analysis and disguised analysis. The results showed that male inpatients were older than female inpatients, with an average age of 46.23 and 48.07 years old, respectively. Three types of antipsychotics were used in this hospital, including the first generation antipsychotics (FGAs), the second generation antipsychotics (SGAs), and injection formations. The SGAs were the most commonly used among them (50.75%). The frequency orders of medication combination were antipsychotics with psychotropic, antianxiety drug, and hypnotics, respectively. The most frequently used antipsychotics were Haloperidol (is a FGAs), Aripeprazole (is a SGAs), and clopenthixol deanoate (a long-acting injection form). It is well known that antipsychotics often induces extrapyramidal syndrome, therefore, the combination of antipsychotics and antiparkinson’s disease medicines was also included in this study. The result showed that haloperidol and risperidone had highest combination rate.The research data showed no difference between the medications used in this hospital and other psychiatric hospitals in Taiwan. The polypharmacy issue was often raised from the consideration of antipsychotics efficacy, side effects, as well as pharmacoeconomics. Compliance of antipsychotics is the cornerstone to prevent the recurrence of disease. Pharmacists thus may play an important role on the efficacy of therapy. Therefore, future study should focus on intervention of pharmacist.Keywords: schizophrenia, antipsychotics, psychotropics, polypharmacy |
