服用抗精神病藥物治療之思覺失調症病人的便秘盛行率調查

Prevalence of Antipsychotic Drugs Related to Constipation in Patients with Schizophrenia

目的：便秘是抗精神病藥物所造成最普遍也是最容易忽略的副作用，目前台灣本土的資料卻相對匱乏。在本研究中，我們要調查思覺失調症門診病人有便秘的盛行率，及造成病人便秘的危險因素。方法：我們運用回溯性研究在南台灣某精神科專科醫院取樣並分析便秘及其他變異數之間的關係。結果：本研究的主要發現為：台灣思覺失調症病人便秘的高盛行率(28.10%) 與女性（風險性 (odds ratio) = 2.12，95% 信度差距 (95% confi dence interval) = 1.76 -2.55, p < 0.01）、年紀較大 (OR = 1.02, 95% CI = 1.76 - 2.55, p < 0.01)、精神症狀較為嚴重 (OR= 1.03, 95% CI = 1.01 - 1.04, p < 0.01)，合併其他生理疾病 (OR = 1.99, 95% CI = 1.65 - 2.40, p <0.01) 及使用不同抗精神病藥物 (p < 0.01) 等因素都有顯著的相關。結論：本研究結果可提供臨床工作者對於思覺失調症病人常見之便秘提高警戒並謹慎評估，以確保適切的臨床處置及避免可能之嚴重併發症。

Objective: Constipation is thought to be both common and overlooked in patients with schizophrenia, with no empirical data about its prevalence in the schizophrenic population in Taiwan. In the current study, we intended to investigate prevalence and risk factors of constipation during routine treatment of patients with schizophrenia. Method: We did a retrospective study of inpatients treated with antipsychotic medications in Kaohsiung Kai Syuan Municipal Psychiatric Hospital between January 2008 and December 2013. Totally, 3,107 inpatients diagnosed as schizophrenic were included in this study. Results: The prevalence of constipation was 28.10%. Female gender (odds ratio = 2.12, 95% confi dence interval = 1.76 - 2.55, p < 0.01), older age (OR = 1.02, 95% CI = 1.76 - 2.55, p < 0.01), greater symptom severity (OR = 1.03, 95% CI = 1.01 - 1.04, p < 0.01), and comorbid medical diseases (OR = 1.99, 95% CI = 1.65 - 2.40, p < 0.01) were found to be all signifi cantly positive factors related to the constipation. We also found that the use of second-generation antipsychotic drugs (OR = 1.75, 95% CI =1.24- 2.48, p < 0.01), and the use of SGAs combined with fi rst-generation antipsychotic drugs (OR = 3.78, 95% CI = 2.70 - 5.28, p < 0.01 ) were signifi cantly more likely to cause constipation than the use of FGAs alone. Conclusion: Those fi ndings suggest that clinicians need greater vigilance and active evaluation of constipation in patients with schizophrenia, to ensure appropriate clinical management and to prevent associated complications.