抗精神病藥物與過度飲水相關性評估：以某精神專科教學醫院為例

Association between Antipsychotic Agents and Primary Polydipsia in Psychiatric Patients

楊茹蘭(Ju-Lan Yang)

指導教授 ： 蔡東榮

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2013年)

摘要

【背景與目的】
當個案在無關正常口渴機制或體內水分平衡需要等不明原因下飲用大量的液體，可能就是一種原發性過度飲水的徵候。精神病人的死因可能是由於未被診斷出的過度飲水引起水中毒所導致，因為過度飲水問題不易察覺及確診，使得隨之引起的相關共病症及死亡容易為人忽略，所以當個案出現持續不停的喝水行為時，應即刻介入處理以避免後續不良結果。
本研究主要目的為討論精神科住院病人發生過度飲水的人口學特徵及臨床特性，並評估精神作用藥物使用與過度飲水行為的相關性。
【研究方法】
以回溯性病歷回顧研究，收集於2010年至2011年間，在台灣南部某精神專科教學醫院符合有過度飲水的住院精神病患的病歷資料。依研究對象人口學特徵及醫療處置，探討過度飲水在該群病人中相關的危險因子及精神作用藥物(抗精神病藥物和抗膽鹼藥物)使用狀況進行分析。
【結 果】
134名研究對象中過度飲水個案共67位，與對照組非過度飲水個案進行病例對照分析。該機構住院病患過度飲水比例為5.58%，這群個案平均年齡48.37（SD: 9.944，p=0.931）歲，有65.1%個案發病時間大於20年(χ2=9.371, p=0.009)，91.0%診斷為精神分裂症 (χ2=16.508, p<0.001)，且50.0%個案有抽菸習慣 (χ2=6.574, p=0.010)；二組分別在性別、婚姻、教育程度、住院天數與次數、併發其他身體疾病及飲酒習慣上則無統計學上差異顯著性(p>0.05)。
在醫療處置方面，過度飲水個案在住院期間平均發生2.69 (SD: 5.541，p<0.001) 次低血鈉事件，該族群在總隔離次數(平均14.46，SD: 29.548次)、發生低血鈉的隔離次數(平均2.67，SD: 6.170次)及早晚體重增加超過4%的隔離次數(平均11.15，SD: 23.691次)與非過度飲水個案的差異均有達到統計學上顯著性(p<0.001、0.001和<0.001)。
在精神作用藥物處方型態方面，有38.8%過度飲水個案處方中重覆使用抗精神病藥物(χ2=5.132, p=0.023)，且併用抗膽鹼藥物的比例達64.2%(χ2=6.740, p=0.009)；有無過度飲水二組在抗精神病藥物使用種類上則未見有統計學差異顯著性(χ2=1.696, p=0.428)。
【結 論】
慢性化精神分裂症病人發生過度飲水行為的比例要高出其他族群許多，部分病人在長期過度飲水之後可能出現低血鈉表現，增加罹患疾病風險與死亡率。如何防範這群個案進一步發生水中毒或其他併發的身體疾病，並積極辨識出這類病人，成為臨床醫療人員所必須謹慎面對的難題，也是精神醫療照護中重要的課題，值得吾人持續關注。

關鍵字

原發性過度飲水 ； 精神分裂症 ； 精神科住院病人

並列摘要

【Background】
Primary polydipsia is a syndrome in which a person intakes fluids substantially beyond physiologic need due to obscure reasons unrelated to normal thirst or homeostatic needs. Polydipsia is commonly associated with chronic psychiatric illness. Psychotic patients with polydipsia can produce morbidity and possibly death due to hyponatremia and water intoxication.
The aim of this study was to determine the clinical and socio-demographic factors of polydipsia in psychotic inpatients and to evaluate the association between prescribed antipsychotic drugs and this disorder.
【Method】
A retrospective survey of psychiatric inpatients during 2010-2011 at a mental hospital was done. The basic and clinical data of the subjects were collected from medical records. We examined and analyzed the difference of medical, demographic factors and prescribed psychotropic agents in this population.
【Result】
A total of 134 psychiatric inpatients were included, in which 67 cases were polydipsia. Prevalence of polydipsia in psychotic inpatients was 5.58%. The group with polydipsia was significantly having longer mental illness duration, more frequently having schizophrenia diagnosis, smoking habits and hyponatremia episodes, compared to the group without polydipsia. The study also found, prescribed anticholinergic agents and antipsychotic polypharmacy were significantly different among polydipsia and non-polydipsia patients. The two groups did not differ in marital status, education level, drinking habits and the types of prescribed antipsychotic agents.
【Conclusion】
Our findings suggest that primary polydipsia is not infrequent among the patients with chronic schizophrenia. Polydipsia might induce life-threatening complications in this population; nevertheless, it is remarkable how little sound information has been acquired about the treatment of these conditions. To recognize the sign of polydipsia become an important issue.

並列關鍵字

primary polydipsia ； schizophrenia ； psychiatric inpatient

參考文獻

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