Pharmacotherapy of psychiatric inpatients with mental and behavioral disorders caused by sedatives or hypnotics (F13): Results from an observational pharmacovigilance program between 2000 and 2017.
Philipp Pauwels, Beatrice Haack, Sermin Toto, Johanna Seifert, Renate Grohmann, Martin Heinze, Oliver Zolk, Phileas Johannes Proskynitopoulos, Michael Schneider, Timo Greiner
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引用次数: 0
Abstract
Background: The treatment of choice for substance use disorder (SUD) caused by sedatives, hypnotics, and anxiolytics (SHA) is to slowly taper the dose of the implicated substance to the point of abstinence, thereby minimizing withdrawal symptoms. Concomitant pharmacotherapy may be indicated to manage excessive withdrawal or rebound symptoms. This study investigated the use of psychotropic drugs for the treatment of SHA-dependent SUD patients in Germany.
Methods: Data were obtained from the German Drug Safety Program in Psychiatry ("Arzneimittelsicherheit in der Psychiatrie"; AMSP) from 2000 to 2017. SHA SUD was classified using the 10th Edition of the International Classification of Disease (ICD-10).
Results: The present study included 1,015 patients with a primary diagnosis of mental and behavioral disorders due to use of sedatives or hypnotics (F13.1-F13.9). The most common comorbid psychiatric diagnoses were additional SUDs (F1, n = 279), especially alcohol use disorder (F10; n = 124), and mood disorders (F3; n = 201). A total of 95.6% of patients received one or more psychotropic drugs, most commonly antidepressant drugs (63.1% of patients), tranquillizing drugs (55.5%), and antipsychotic drugs (46.7%). The most common combination was an antidepressant drug and a tranquillizing drug (33.0%). Overall, psychotropic drugs with sedating properties (e.g., mirtazapine, quetiapine, doxepin, and trimipramine) were preferred. An increase in use over the 17-year observation period was observed for tranquillizing drugs and, most pronounced, for antipsychotic drugs.
Conclusion: We found high rates of non-SHA drugs among patients treated for SHA-SUD. The prevalent use of psychotropic drugs with strong sedating properties indicates a symptom-oriented treatment approach, which is often "off-label" but may be clinically necessary. Main limitation is the cross-sectional design of the AMSP databank. Therefore, we cannot provide any follow up data on the patient collective especially regarding outcome.
背景：由镇静剂、催眠药和抗焦虑药（SHA）引起的物质使用障碍（SUD）的治疗选择是逐渐减少相关物质的剂量，直至戒断，从而最大限度地减少戒断症状。伴随药物治疗可用于控制过度戒断或反弹症状。本研究调查了在德国使用精神药物治疗sha依赖性SUD患者的情况。方法：数据来自德国精神病学药物安全计划(“Arzneimittelsicherheit in der Psychiatry”；AMSP)从2000年到2017年。根据第十版《国际疾病分类》（ICD-10）对SHA SUD进行分类。结果：本研究纳入了1015例因使用镇静剂或催眠药而被初步诊断为精神和行为障碍的患者（F13.1-F13.9）。最常见的精神科共病诊断是额外的sud (F1, n = 279)，尤其是酒精使用障碍(F10；n = 124)，情绪障碍(F3；n = 201)。95.6%的患者接受过一种或多种精神药物治疗，最常见的是抗抑郁药物（63.1%），镇静药物（55.5%）和抗精神病药物（46.7%）。最常见的组合是抗抑郁药物和镇静药物（33.0%）。总的来说，具有镇静作用的精神药物（如米氮平、喹硫平、多虑平和三氯丙胺）是首选。在17年的观察期内，镇定剂药物的使用有所增加，抗精神病药物的使用最为明显。结论：SHA-SUD患者非sha类药物使用率较高。具有强镇静特性的精神药物的普遍使用表明一种以症状为导向的治疗方法，这通常是“标签外”的，但可能是临床必要的。主要的限制是AMSP数据库的截面设计。因此，我们不能提供任何关于患者集体的随访数据，特别是关于结果的数据。
期刊介绍：
Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings.
Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use.
Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations.
Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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