抗精神病藥物與失智症之死亡風險－實証之個案報告

The Mortality Risk Caused by Atypical Antipsychotics on Dementia: An Evidence-Based Case Report

劉瑞婷(Jui-Ting Liu) ； 廖以誠(Yi-Cheng Liao) ； 邱南英(Nan-Ying Chiu)

《台灣老年醫學雜誌》 2卷1期 (2006/08) Pp. 32-41

https://doi.org/10.29462/TGG.200608.0003

摘要

失智症病患出現精神症狀徵候與行為問題常是照顧者面臨的最大難題，導致他們尋求醫療協助且影響生活品質。目前臨床醫師除了非藥物處置介入外，大多會合併使用抗精神病藥物（特別是非典型抗精神病藥物）來治療。但美國藥物食品管理局於2005年曾提出警告在這類病患身上使用非典型抗精神病藥物會增加1.6至1.7倍的死亡率，令許多家屬開始擔心目前藥物治療的危險性。
本報告呈現一真實案例，描述門診醫師如何以實證醫學之手法，找尋最佳研究證據，告知家屬目前最可靠的證據顯示繼續使用非典型抗精神病藥物可能會比不用藥增加約1.54倍（最高2.23倍）的死亡率，如果以危險增加的絕對值來看，每一百個使用非典型抗精神病藥物的病患比不服用的病患，會增加一個死亡案例。據此提供家屬治療資訊與建議，並進一步和家屬溝通並共同達成較適合的治療方式。
此外，在此報告中也同時呈現與此議題相關的文獻回顧，並簡介實證醫學的步驟及臨床應用，希望能提供臨床醫師一些新的思維。

關鍵字

失智症 ； 非典型抗精神病藥物 ； 死亡 ； 實證醫學

並列摘要

The behavioral and psychiatric symptoms of dementia (BPSD) are the most troublesome matters faced by caregivers prompting them to seek medical help. Currently, most clinicians combine non-pharmacological interventions with antipsychotics to treat those symptoms in moderate to severe level. However, in April 2005, the FDA issued a public health advisory regarding the increasing risk of overall mortality associated with the use of all atypical antipsychotics in demented elderly people. This warning worries families of patients with BPSD.
This case report demonstrated how the clinician adopts the method of evidence-based medicine to make clinical decision and provide suggestions. Reliable evidence reveals that continuing the use of atypical antipsychotics carries with it a mortality rate 1.54 times (maximal: 2.33 times) greater than the placebo use. In terms of absolute value of increasing risk, there may be 1 more death in every 100 patients treated by atypical antipsychotics than placebo (Number Needed to Harm=100). The clinician offered the evidence-based recommendation, and discussed it with the family to reach a best consensus on the patient's treatment plan.
We performed the literature review and introduced the procedure and clinical implications of evidence-based medicine in this patient.

並列關鍵字

dementia ； atypical antipsychotics ； death ； evidence-based medicine