老年精神疾病患者抗焦慮劑、鎮靜安眠藥物處方趨勢與型態探討

Prescriptions of Anxiolytics and Hypnotics/Sedatives among Elderly Patients with Psychiatric Illnesses

目的：近年來世界各國老年人使用抗焦慮劑、鎮靜安眠藥物日漸普及，其臨床適應症與使用的安全性成為重要議題。研究主要目的乃藉由個案醫院之資料進行分析，以瞭解該院老年人抗焦慮劑、鎮靜安眠藥物處方態樣。方法：回溯性資料庫研究，分析某一精神專科醫院門診健保資料庫，針對65歲以上人口為研究對象，探討2006年至2015年老年人抗焦慮劑、鎮靜安眠藥物之處方趨勢與型態，並以Cochran-Armitage test進行趨勢雙尾檢定。結果：於2006至2015年間，老年人每人每年抗焦慮劑、鎮靜安眠藥物處方箋佔率由65.21%下降至60.99%(p<0.0001)。其中，抗焦慮劑由31.45%顯著增加至35.07%(p<0.001)，而鎮靜安眠藥物則由56.55%顯著下降至52.53%(p<0.05)。羅吉斯迴歸分析顯示，於抗焦慮劑、鎮靜安眠藥物的使用，高年及女性有較低的開立機率，但是有重大傷病的患者有較高的開立機率。結論：抗焦慮劑、鎮靜安眠藥物對於治療老年失眠及焦慮等精神疾患扮演著重要的角色，然其使用相關因子及副作用與安全性分析，仍需要更多研究，以期在臨床使用中兼顧藥物療效與安全，同時增進老年病人之藥物治療品質與用藥安全。

Objectives. The prescription of anxiolytics and hypnotics/sedatives for elderly patients with psychiatric illnesses is increasing over the world. No studies have focused on the prescription trends and patterns of anxiolytics and hypnotics/sedatives for elderly patients in psychiatric hospitals in Taiwan.
Methods. For this retrospective study of all outpatients 65 years of age or older in one psychiatric hospital in Taiwan, we reviewed and collected patient data from hospital medical records from 2006 to 2015. Reviewing our electronic medical information system, we extracted patients’demographic data such as sex and age as well as psychiatric diagnosis and prescription history for anxiolytics and hypnotics/sedatives.
Results. During the study period, the proportion of participants receiving anxiolytics and hypnotics/sedatives decreased significantly, from 65.21% in 2006 to 60.99% in 2015 (p<0.001). The proportion of participants receiving anxiolytics increased from 31.45% in 2006 to 35.07% in 2015 (p<0.001) but those receiving hypnotics/sedatives decreased from 56.55% to 52.53% (p<0.05). Logistic regression showed that older age and female gender were associated with less use of anxiolytics and hypnotics/sedatives. Catastrophic illnesses were associated with more use of them.
Conclusion. Like many studies worldwide, Taiwan has seen a decrease in prescriptions for anxiolytics and hypnotics/sedatives for psychiatric patients above 65 years of age. In spite of the potential benefits of anxiolytics and hypnotics/sedatives, physicians should remain aware of the potential side effects of their long-term use.