Waldemar Greil, Mateo de Bardeci, Nadja Nievergelt, Andreas Erfurth, Gregor Hasler, Rene Bridler, Sermin Toto, Renate Grohmann, Johanna Seifert, Georgios Schoretsanitis
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引用次数: 0
摘要
背景：全球药物流行病学证据表明双相情感障碍患者处方模式的动态变化。我们评估了在住院患者双相情感障碍管理中使用的药理学药物的趋势。方法：我们检查了精神病学药物安全项目AMSP（德语：“Arzneimittelsicherheit in der Psychiatry”）提供的药物使用数据，包括德国、奥地利和瑞士的精神病院。我们纳入了1994年至2017年间治疗的成年双相情感障碍住院患者（ICD-10: F31）的数据。我们比较了接受含锂和不含锂治疗方案的患者之间的处方模式。躁狂和抑郁发作的患者也分别进行分析。结果：共纳入8707例患者（女性58%，平均年龄50.8±14.8岁）。我们的分析显示，锂的使用减少（直到2004年），第二代抗精神病药物（SGA）的处方率持续增加，其中喹硫平（n = 2677）和奥氮平（n = 1536）最常见。在精神药物中，喹硫平与锂的合用最多（n = 716, 25.6%）。与未接受锂治疗的患者相比，接受锂治疗的患者接受的药物数量更多（接受锂治疗的患者与未接受锂治疗的患者的平均药物数量为4.99,n = 2796 vs. 4.75, n = 5911, p = 0.002）。锂组使用甲状腺药物较多，丙戊酸盐和喹硫平较少。超过60%的双相抑郁发作患者一直服用抗抑郁药。结论：我们的研究结果表明，SGAs正逐渐成为双相情感障碍的主要治疗选择，不断取代锂。抗抑郁药的使用率仍然高得令人担忧。我们呼吁采取行动，加强对循证指南的遵守。
Twenty-four years of prescription patterns in bipolar disorder inpatients with vs without lithium: a pharmacoepidemiological analysis of 8,707 cases in German-speaking countries.
Background: Global pharmacoepidemiological evidence suggests dynamically changing prescription patterns in patients with bipolar disorders. We assessed trends in the use of pharmacological agents used in the management of bipolar disorders in inpatients.
Methods: We examined drug use data provided by the Drug Safety in Psychiatry Programme AMSP (German: "Arzneimittelsicherheit in der Psychiatrie"), including psychiatric hospitals in Germany, Austria and Switzerland. We included data from adult inpatients with bipolar disorders (ICD-10: F31) treated between 1994 and 2017. We compared prescription patterns between patients receiving therapeutic regimens with vs. without lithium. Patients with manic and depressive episodes were also analyzed separately.
Results: We identified a total of 8,707 patients (58% females, mean age 50.8 ± 14.8 years). Our analysis revealed a decrease of lithium use (up to 2004) and a consistent increase of prescription rates for second-generation antipsychotics (SGA) among which quetiapine (n = 2,677) and olanzapine (n = 1,536) were the most common. Among psychotropic drugs, quetiapine was most frequently combined with lithium (n = 716, 25.6%). Lithium-treated patients received a higher number of drugs compared to patients not receiving lithium (mean number of drugs in patients with vs. without lithium 4.99, n = 2,796 vs. 4.75, n = 5,911, p = 0.002). Thyroid therapeutics were given more often, valproate and quetiapine less often in the lithium group. Antidepressants were consistently prescribed to more than 60% of patients with bipolar depressive episodes.
Conclusions: Our findings suggest that SGAs are gradually becoming the mainstay treatment option in bipolar disorder, continuously replacing lithium. The use of antidepressants remains concerningly high. We call for action to improve adherence to evidence-based guidelines.
期刊介绍：
The International Journal of Bipolar Disorders is a peer-reviewed, open access online journal published under the SpringerOpen brand. It publishes contributions from the broad range of clinical, psychological and biological research in bipolar disorders. It is the official journal of the ECNP-ENBREC (European Network of Bipolar Research Expert Centres ) Bipolar Disorders Network, the International Group for the study of Lithium Treated Patients (IGSLi) and the Deutsche Gesellschaft für Bipolare Störungen (DGBS) and invites clinicians and researchers from around the globe to submit original research papers, short research communications, reviews, guidelines, case reports and letters to the editor that help to enhance understanding of bipolar disorders.
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