中华精神科杂志
中華精神科雜誌
중화정신과잡지
CHINESE JOURNA OF PSYCHIATRY
2012年
1期
29-34
,共6页
司天梅%舒良%于欣%马崔%王高华%白培深%刘协和%孙立忠%师建国%陈宪生%梅其一%栗克清
司天梅%舒良%于訢%馬崔%王高華%白培深%劉協和%孫立忠%師建國%陳憲生%梅其一%慄剋清
사천매%서량%우흔%마최%왕고화%백배심%류협화%손립충%사건국%진헌생%매기일%률극청
双相情感障碍%抽样研究%处方,药物
雙相情感障礙%抽樣研究%處方,藥物
쌍상정감장애%추양연구%처방,약물
Bipolar disorder%Sampling studies%Prescription,drug
目的 调查2006年我国10省市双相障碍患者药物治疗现况.方法 根据经济发展水平,按照方便取样原则,在我国10省市41所精神疾病专科医院或综合医院精神科,选择760例年龄16～65岁,符合国际疾病分类第10版精神和行为障碍分类双相情感障碍诊断标准,接受精神药物治疗的双相障碍门诊和住院患者,于2006年5月22-28日使用自制修订的调查问卷调查双相障碍患者药物治疗的处方方式.结果 (1)760例患者中,门诊患者为329例(43.3％)；住院患者为431例(56.7％)；男436例(57.4％),女318例(41.8％),缺失6例(0.8％)数据.(2) ＞2/3的患者表现为情感高涨(481例,63.3％)、活动增多(513例,67.5％)及思维奔逸(436例,57.4％),162例(21.3％)患者以抑郁表现为主,60例(7.9％)患者伴有精神病性症状,48例(6.3％)患者有自杀观念或行为.住院患者处于急性治疗期、伴精神病性症状的患者比例显著高于门诊患者,并且功能损害更严重.(3)671例(88.3％)患者接受心境稳定剂治疗,主要是碳酸锂和丙戊酸盐；593例(78.0％)患者接受了抗精神病药治疗,按照使用频率高低前5种药物分别是:氯氮平、利培酮、氯丙嗪、奎硫平和氟哌啶醇；142例(18.7％)患者接受了抗抑郁药治疗,其中78例(63.4％)选择新型抗抑郁药选择性5-羟色胺再摄取抑制剂.(4)住院患者使用抗精神病药的比例明显高于门诊患者(87.0％vs 66.3％,x2=46.835,P=0.000),门诊患者接受抗抑郁药治疗的比例显著高于住院患者(22.5％ vs 15.8％,x2=5.538,P=0.019).(5)606例(79.8％)的患者联合2种或3种药物治疗,主要治疗方案是心境稳定剂联合抗精神病药,双相抑郁发作以心境稳定剂联合抗抑郁药治疗为主.(6)患者对治疗药物(抗精神病药、心境稳定剂或抗抑郁药)的选择受不同临床症状的影响(P＜0.05).结论 临床实践中,双相障碍以联合治疗为主,心境稳定剂联合抗精神病药及联合抗抑郁药分别是双相躁狂和双相抑郁患者的主要治疗方案,治疗药物选择主要受患者临床症状的影响.
目的 調查2006年我國10省市雙相障礙患者藥物治療現況.方法 根據經濟髮展水平,按照方便取樣原則,在我國10省市41所精神疾病專科醫院或綜閤醫院精神科,選擇760例年齡16～65歲,符閤國際疾病分類第10版精神和行為障礙分類雙相情感障礙診斷標準,接受精神藥物治療的雙相障礙門診和住院患者,于2006年5月22-28日使用自製脩訂的調查問捲調查雙相障礙患者藥物治療的處方方式.結果 (1)760例患者中,門診患者為329例(43.3％)；住院患者為431例(56.7％)；男436例(57.4％),女318例(41.8％),缺失6例(0.8％)數據.(2) ＞2/3的患者錶現為情感高漲(481例,63.3％)、活動增多(513例,67.5％)及思維奔逸(436例,57.4％),162例(21.3％)患者以抑鬱錶現為主,60例(7.9％)患者伴有精神病性癥狀,48例(6.3％)患者有自殺觀唸或行為.住院患者處于急性治療期、伴精神病性癥狀的患者比例顯著高于門診患者,併且功能損害更嚴重.(3)671例(88.3％)患者接受心境穩定劑治療,主要是碳痠鋰和丙戊痠鹽；593例(78.0％)患者接受瞭抗精神病藥治療,按照使用頻率高低前5種藥物分彆是:氯氮平、利培酮、氯丙嗪、奎硫平和氟哌啶醇；142例(18.7％)患者接受瞭抗抑鬱藥治療,其中78例(63.4％)選擇新型抗抑鬱藥選擇性5-羥色胺再攝取抑製劑.(4)住院患者使用抗精神病藥的比例明顯高于門診患者(87.0％vs 66.3％,x2=46.835,P=0.000),門診患者接受抗抑鬱藥治療的比例顯著高于住院患者(22.5％ vs 15.8％,x2=5.538,P=0.019).(5)606例(79.8％)的患者聯閤2種或3種藥物治療,主要治療方案是心境穩定劑聯閤抗精神病藥,雙相抑鬱髮作以心境穩定劑聯閤抗抑鬱藥治療為主.(6)患者對治療藥物(抗精神病藥、心境穩定劑或抗抑鬱藥)的選擇受不同臨床癥狀的影響(P＜0.05).結論 臨床實踐中,雙相障礙以聯閤治療為主,心境穩定劑聯閤抗精神病藥及聯閤抗抑鬱藥分彆是雙相躁狂和雙相抑鬱患者的主要治療方案,治療藥物選擇主要受患者臨床癥狀的影響.
목적 조사2006년아국10성시쌍상장애환자약물치료현황.방법 근거경제발전수평,안조방편취양원칙,재아국10성시41소정신질병전과의원혹종합의원정신과,선택760례년령16～65세,부합국제질병분류제10판정신화행위장애분류쌍상정감장애진단표준,접수정신약물치료적쌍상장애문진화주원환자,우2006년5월22-28일사용자제수정적조사문권조사쌍상장애환자약물치료적처방방식.결과 (1)760례환자중,문진환자위329례(43.3％)；주원환자위431례(56.7％)；남436례(57.4％),녀318례(41.8％),결실6례(0.8％)수거.(2) ＞2/3적환자표현위정감고창(481례,63.3％)、활동증다(513례,67.5％)급사유분일(436례,57.4％),162례(21.3％)환자이억욱표현위주,60례(7.9％)환자반유정신병성증상,48례(6.3％)환자유자살관념혹행위.주원환자처우급성치료기、반정신병성증상적환자비례현저고우문진환자,병차공능손해경엄중.(3)671례(88.3％)환자접수심경은정제치료,주요시탄산리화병무산염；593례(78.0％)환자접수료항정신병약치료,안조사용빈솔고저전5충약물분별시:록담평、리배동、록병진、규류평화불고정순；142례(18.7％)환자접수료항억욱약치료,기중78례(63.4％)선택신형항억욱약선택성5-간색알재섭취억제제.(4)주원환자사용항정신병약적비례명현고우문진환자(87.0％vs 66.3％,x2=46.835,P=0.000),문진환자접수항억욱약치료적비례현저고우주원환자(22.5％ vs 15.8％,x2=5.538,P=0.019).(5)606례(79.8％)적환자연합2충혹3충약물치료,주요치료방안시심경은정제연합항정신병약,쌍상억욱발작이심경은정제연합항억욱약치료위주.(6)환자대치료약물(항정신병약、심경은정제혹항억욱약)적선택수불동림상증상적영향(P＜0.05).결론 림상실천중,쌍상장애이연합치료위주,심경은정제연합항정신병약급연합항억욱약분별시쌍상조광화쌍상억욱환자적주요치료방안,치료약물선택주요수환자림상증상적영향.
Objective To understand the treatment patterns for bipolar disorders in China in 2006.Methods Based on the economic level,760 out- and in-patients,aged 16 -65 years and meeting the ICD-10 criteria for bipolar disorder were selected from 41 hospitals in 10 provinces and municipalities using the convenient sampling.The investigation was conducted during 22th -28th May,2006,using the retested and revised self-made modified questionnaires.Results ( 1 ) Totally 760 cases including 329 (43.3％ ) outpatients and 431 (56.7 ％ ) inpatients ( male:female =436:318,missing value was 6 ) were recruited in the study.(2) Two thirds of patients experienced elation (n =481,63.3％ ),flight of thought (n =436,57.4％ ) and hyperactivity ( n =513,67.5％ ),and 21.3％ patients ( n =162) were bipolar depression.And 7.9％ ( n =60) of patients experienced psychotic symptoms,and 6.3％ of them ( n =48) manifested suicide idea or behaviors.More inpatients were severe and in the acute phase than outpatients.(3) 88.3％ of the patients were treated with mood stabilizer,most frequently prescribed were lithium and valproate.The antipsychotics were used in 78％ of all the patients,with the most five medications being clozapine,risperidone,chlorpromazine,quetiapine and haloperidone.18.7％ (n =142) of the patients were prescribed antidepressants,the first-line drugs were SSRIs. (4) More inpatients were treated with the antipsychotics and more outpatients with antidepressants.(5) 79.8％ of patients (n =606) were treated with two or more kinds of medications,with first-line strategy of combination of antipsychotics and mood stabilizers.(6) Results from the logistic analysis showed that the clinical profile,including experiencing psychotic symptoms,depressive or manic moods played the important role in using the antipsychotics,mood stabilizers or antidepressants treatment.Conclusion The polypharmacy is the mainstream in treatment of bipolar disorder,with the combination of antipsychotics and mood stabilizers being the first-line choice. The prescription pattern for bipolar disorder is correlated to clinical characteristics of patients.
