정신건강의학과 입원 환자의 항정신병약물 사용 변화

Changes in Antipsychotic Drug Usage in the Psychiatric Inpatients at a University Hospital between 1997, 2003-2004 and 2009-2010

본 연구의 결과를 통하여 정신병적 증상을 보이는 환자에 대한 약물 치료에 있어 전형 항정신병약물 대신 비정형 항정신병약물이 최우선적인 선택으로 고려됨을 확인하였다. 이는 비정형 항정신병약물의 우수한 치료 효과와 적은 부작용, 조현병 이외 정신과 질환에서의 처방 증가와 관련이 있을 것이다. 또한 더 우수한 약물 효능에 대한 기대에 따라 두 가지 이상의 항정신병약물 다종약물요법 처방이 증가되었음을 볼 수 있었다. 그러나 이러한 경우 의료비용의 증가 또는 약물상호작용의 위험성, 부작용의 증가에 대한 고려가 필요할 것이다.

Objective Patterns of clinical use of antipsychotics have changed greatly in the past decade. The authors’ goal was to examine these patterns in an inpatient unit at a university hospital between 1997, 2003-2004, and 2009-2010. Methods We evaluated medication use in inpatients treated with antipsychotic drugs during 2009-2010 (n=379) and compared the results with inpatients treated with antipsychotics in 2003-2004 (n=379) and inpatients treated with antipsychotics in 1997 (n=165). Results The distribution of psychiatric diagnoses in 2009-2010 was different from that in 2003-2004 and 1997. The proportion of patients with schizophrenia spectrum disorders was higher in 2009-2010 (p=0.013, p<0.001). An atypical agent was prescribed for 98.7% (n=374) of patients in 2009-2010. This represents a significant proportional increase over both 2003-2004 (93.7%, n=355; p<0.001) and 1997 (57.6%, n=95; p<0.001). In 2009-2010 the number of patients receiving prescriptions of two or more antipsychotics in combination was 16.1% (n=61), which represents a significant proportional increase over 2003-2004 (9.0%, n=34; p=0.007) and 1997 (4.8%, n=8; p=0.001). Conclusion The present study demonstrates that atypical antipsychotic medications have replaced typical antipsychotic medications. Polypharmacy increased markedly despite limited empirical evidence of cost-risk-benefit relationships.