일 대학병원 정신증 환자에서 항정신병약물 병용요법의 사용

Antipsychotic Polypharmacy in the Treatment of Patients with Related Psychoses at a University Hospital

본 연구 결과 일 대학 정신과 전문병원에서 정신증으로 치료받은 환자들 중 47.3%는 항정신병약물 병용요법을 사용하고 있었다. 병용요법에서 가장 많이 사용된 조합은 quetiap-ine과 risperidone의 조합이었다. 그러나 항정신병약물의 병용요법은 고용량의 항정신병약물의 사용과 밀접한 관계가 있어, 사용시 용량 조절에 주의를 기울일 필요가 있다.

Objective The practice of antipsychotic polypharmacy is common, despite lack of supporting evidence. The aims of this study were to estimate the prevalence of antipsychotic polypharmacy in a psychiatric university hospital in Korea and find out the clinical factors associated with antipsychotic polypharmacy. Methods We reviewed medical records of the patients discharged from Severance Mental Health Hospital (SMH) for the period of 1, January to 31, December 2010. Patients should be diagnosed as having schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder or psychotic disorder not otherwise specified. Results In 2010, 260 patients in SMH were prescribed with antipsychotics and 47.3% (n=123) of them were discharged under antipsychotic polypharmacy treatment. The most commonly prescribed antipsychotics for combination therapy was quetiapine (n=64). The most prevalent combination of drugs was risperidone plus quetiapine (n=20). Logistic regression analysis showed that the use of high-dose antipsychotics, first-generation antipsychotics, and long hospital duration were significantly associated with antipsychotic polypharmacy. Conclusion Although the controlled evidence for efficacy and safety as a strategy remains inconclusive, antipsychotic polypharmacy is a common pharmacological strategy as it is illustrated in our study. Considering high antipsychotic doses related with antipsychotic polypharmacy, careful monitoring of side effect and efficacy is needed.