摘要
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％VS66．3％，χ2=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％vs15．8％，χ2=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。
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 fi＇om 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 antipsychoties 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 antipsychoties 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.
出处
《中华精神科杂志》
CAS
CSCD
北大核心
2012年第1期29-34,共6页
Chinese Journal of Psychiatry
关键词
双相情感障碍
抽样研究
处方
药物
Bipolar disorder
Sampling studies
Prescription,drug
