- 期刊
某精神專科醫院慢性住院病人抗精神病藥物處方型態對維持心肺耐力良好之回溯病例對照研究
The Case-Control Study on the Associations between Antipsychotic Drug Administration and Cardiorespiratory Endurance Outcome
摘要
目的：主要目的為分析抗精神病藥物月單複方（one drug or polypharmacy）、月平均日劑量（Defined Daily Dose ,DDD）對心肺耐力維持良好的機率是否有關；次要目的為了解職能治療階段對心肺耐力維持良好機率的影響。方法：採回溯病例對照研究（case‐control study）設計；研究對象為本院慢性住院精神病人，回溯期間為2017.07～2018.07年。個案納入條件為2017～2018年間每人至少1筆月健保申報資料且同次住院期間抗精神病藥物的使用天數大於14天。本研究以心肺耐力維持好者為case組（以下簡稱”維持好組”），計212人；心肺耐力改善者為control組（以下簡稱”改善組”），計96人；故樣本總人數為308人。因抗精神病藥物資料為人月檔，須以樣本3,678人月分析因果關係。結果：控制干擾因素（職能階段變化、月職能階段、初始職能階段、性別、疾病診斷、年齡、發病年齡）之後，在月單複方部分，單方抗精神病藥物比起複方抗精神病藥物，心肺耐力維持好的機率平均顯著多10.1%（p<0.05）；惟，月平均日劑量卻與心肺耐力維持好的機率無顯著關係（p>0.05）。在職能階段變化中，有進有退階比維持階在心肺耐力維持好顯著多4.4%（p<0.05），有進有退階比只退階在心肺耐力維持好顯著多7.6%（p<0.05）。初始職能階段越高，心肺耐力維持好的機率亦越高（p<0.05）。結論：抗精神病藥物單複方、職能階段變化與初始職能階段等均會影響維持心肺耐力良好的機率。
並列摘要
Objective. This study aimed to explore (a) the relationships between the cardiorespiratory endurance outcome and antipsychotic drug use including single-drug vs. polypharmacy use and defined daily does (DDD), and (b) the relationships between the status of change in occupational recovery stages and the cardiorespiratory endurance outcomes. Methods. This was a case-control study with inpatients (n=308) from a regional psychiatric center in central Taiwan between July 2017 and July 2018. Inclusion criteria included a minimum of one insurance transaction of antipsychotic prescription per month and the antipsychotic drug administration for 14 or more days per month during the hospitalization. The case group consisted of 212 participants who maintained a "good" cardiorespiratory endurance outcome and the control group 96 participants who "improved" the cardiorespiratory endurance outcome. We collected and analyzed the existing antipsychotic administration data per person and month, which yielded a total of 3678 data entries (n=3678 person/month). Results. With all potential confounding factors including the status of change in the occupational recovery stages, gender, diagnoses, age, and disease onset age accounted for, a multiple logistic regression revealed that single-drug administration resulted in a 10.1% higher chance of maintaining a good cardiorespiratory endurance outcome than polypharmacy use (p<0.05). There was no significant relationship between the DDD and the cardiorespiratory outcome (p>0.05). Comparisons of status change in the occupational recovery stages during the study course demonstrated that a status of mixed changes (i.e., phase up + phase down) resulted in a 4.4% higher chance of maintaining a good cardiorespiratory endurance outcome than a status of no change (i.e., the same stage throughout) (p<0.05), and that a status of mixed changes led to a 7.6% higher chance of maintaining a good cardiorespiratory outcome than a status of constant regression (i.e., phase down throughout) (p<0.05). Moreover, the higher the occupational recovery stage to start with, the greater the chance of maintaining a good cardiorespiratory outcome. Conclusion. The usage of antipsychotic medication (single-drug vs. polypharmacy), the status change in occupational recovery stages, and the initial occupational recovery stage are associated with the chance of maintaining a good cardiorespiratory endurance outcome.