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

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

目的：收集 2007 至 2011 年間台灣某一精神科專科醫院精神分裂病住院病人使用抗精神 病藥物與抗巴金森藥物的情形，並探討二者之關係。方法：所收集之資料包括住院該年、 年齡、性別、住院日數及與研究有關之精神科藥物。結果：這 5 年來呈現使用第一代抗精神 病藥物遞減與第二代抗精神病藥物漸增之趨勢，有 38.7% 的病人同時使用二種以上之抗精 神病藥物，以第一代與第二代併用最常見。抗巴金森藥物約減少 15% 的使用量，住院日愈 長與高於建議劑量之抗精神病藥物皆會增加併用抗巴金森藥物之機率。在第一代抗精神病 藥物中，以 haloperidol (p < 0.001)、triuoperazine (p < 0.05) 有顯著的常併用抗巴金森藥物， chlorpromazine (p < 0.001) 與 sulpiride (p < 0.001) 有顯著的少併用抗巴金森藥物；在第二代抗 精神病藥物中，以 amisulpiride (p < 0.001)、risperidone (p < 0.001) 與 zotepine (p < 0.001) 有顯 著的常併用抗巴金森藥物，clozapine (p < 0.001)、olanzapine (p < 0.05) 與 quetiapine (p < 0.001) 有顯著的少併用抗巴金森藥物。結論：近幾年來使用第二代抗精神病藥物有增加之趨勢，就 錐體外副作用而言，第二代抗精神病藥物並非具有同質性，宜注意有些第二代抗精神病藥物 仍可能易引起該副作用。

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-gener- ation 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 zot- epine (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 homog- enous group of antipsychotic drugs for the risk potential of extrapyramidal symp- toms (EPS). Having a considerably high rate of EPS possible associated with some SGAs warrants clinical attention.