Changing Patterns of Antipsychotic Prescription and Concomitant Antiparkinson Drug Use at a Taiwanese Psychiatric Hospital

台灣某精神科專科醫院抗精神病藥物型態的改變與併用抗巴金森藥物的現況

吳俞萱(Yu-Hsuan Wu) ； 黃美鳳(Mei-Feng Huang) ； 賴俊揚(Chun-Yang Lai) ； 黃郁惠(Yu-Hui Huang) ； 張鈺姍(Yu-San Chang)

《台灣精神醫學》 27卷4期 (2013/12) Pp. 306-317+4

摘要

Objectives: This study was intended to investigate the prescribing patterns of antipsychotic drugs in hospitalized schizophrenia patients receiving antiparkinson drugs (APDs) at a psychiatric hospital in Taiwan from 2007 to 2011, and to analyze co-prescribing rates of APDs of each antipsychotic drug. Methods: We collected patients' demographic data including information of admission year, age, gender, and length of hospital stay, and their drug-related information. Results: The five-year trend of long-term prescriptions of antipsychotic drugs showed that use of first-generation antipsychotic drugs (FGAs) was decreased, and the use of second-generation antipsychotic drugs (SGAs) was increased. There were 38.7% of the patients receiving antipsychotic polypharmacy, and the rate was highest in those receiving a combination of FGAs and SGAs. Over the study period, the co-prescribing APDs was decreased by 15%. A longer hospital stay (p ＜ 0.001) and using a higher than recommended dose of antipsychotic drugs (p ＜ 0.001) were found to significantly increase a greater risk of co-prescribing APDs. Among the FGAs, haloperidol (p ＜ 0.001) and trifluoperazine (p ＜ 0.05) were found to be associated with a significantly higher risk of co-prescribing APDs; chlorpromazine (p ＜ 0.001) and sulpiride (p ＜ 0.001) were found to be associated with a significantly lower risk of co-prescribing APDs. Among the SGAs, amisulpride (p ＜ 0.001), risperidone (p ＜ 0.001), and zotepine (p ＜ 0.001) were associated with a significantly higher risk of co-prescribing APDs; clozapine (p ＜ 0.001), olanzapine (p ＜ 0.05), and quetiapine (p ＜ 0.001) were associated with a significantly lower risk of co-prescribing APDs. Conclusion: The availability of SGAs had been increased in recent years. The SGAs are not a homogenous group of antipsychotic drugs for the risk potential of extrapyramidal symptoms (EPS). Having a considerably high rate of EPS possible associated with some SGAs warrants clinical attention.

關鍵字

第一代抗精神病藥物 ； 第二代抗精神病藥物 ； 精神分裂病 ； 抗巴金森藥物

並列摘要

Objectives: This study was intended to investigate the prescribing patterns of antipsychotic drugs in hospitalized schizophrenia patients receiving antiparkinson drugs (APDs) at a psychiatric hospital in Taiwan from 2007 to 2011, and to analyze co-prescribing rates of APDs of each antipsychotic drug. Methods: We collected patients' demographic data including information of admission year, age, gender, and length of hospital stay, and their drug-related information. Results: The five-year trend of long-term prescriptions of antipsychotic drugs showed that use of first-generation antipsychotic drugs (FGAs) was decreased, and the use of second-generation antipsychotic drugs (SGAs) was increased. There were 38.7% of the patients receiving antipsychotic polypharmacy, and the rate was highest in those receiving a combination of FGAs and SGAs. Over the study period, the co-prescribing APDs was decreased by 15%. A longer hospital stay (p ＜ 0.001) and using a higher than recommended dose of antipsychotic drugs (p ＜ 0.001) were found to significantly increase a greater risk of co-prescribing APDs. Among the FGAs, haloperidol (p ＜ 0.001) and trifluoperazine (p ＜ 0.05) were found to be associated with a significantly higher risk of co-prescribing APDs; chlorpromazine (p ＜ 0.001) and sulpiride (p ＜ 0.001) were found to be associated with a significantly lower risk of co-prescribing APDs. Among the SGAs, amisulpride (p ＜ 0.001), risperidone (p ＜ 0.001), and zotepine (p ＜ 0.001) were associated with a significantly higher risk of co-prescribing APDs; clozapine (p ＜ 0.001), olanzapine (p ＜ 0.05), and quetiapine (p ＜ 0.001) were associated with a significantly lower risk of co-prescribing APDs. Conclusion: The availability of SGAs had been increased in recent years. The SGAs are not a homogenous group of antipsychotic drugs for the risk potential of extrapyramidal symptoms (EPS). Having a considerably high rate of EPS possible associated with some SGAs warrants clinical attention.

並列關鍵字

first-generation antipsychotic drugs ； second-generation antipsychotic drugs ； schizophrenia ； antiparkinson drugs

參考文獻

Seeman, P,Tallerico, T(1998).Antipsychotic drugs which illicit little or no parkinsonism bind more loosely than dopamine to brain D2 receptors, yet occupy high levels of these receptors.Mol Psychiatry.3,123-34.

Lieberman, JA(2004).Dopamine partial agonists: a new class of antipsychotic.CNS Drugs.18,251-67.

Jones, PB,Barnes, TR,Davies, L(2006).Randomized controlled trial of the effect on quality of life of second-vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1).Arch Gen Psychiatry.63,1079-87.

Miller, DD,Caroff, SN,Davis, SM(2008).Extrapyramidal side-effects of antipsychotics in a randomised trial.Br J Psychiatry.193,279-88.

Peluso, MJ,Lewis, SW,Barnes, TR(2012).Extrapyramidal motor side-effects of first-and second-generation antipsychotic drugs.Br J Psychiatry.200,387-92.