정신건강의학과 입원 환자의 Aripiprazole 사용 변화

Changes in Aripiprazole Usage in the Psychiatric Inpatients at a University Hospital between 2004-2008 and 2009-2013

본 연구의 결과를 통하여 최근 aripiprazole의 처방에 있어 양극성장애의 치료 및 주요우울장애에서 부가요법 등 기분장애에서의 사용이 증가하였음을 알 수 있었다. 이는 aripiprazole이 체중증가, 당 내성 및 대사증후군, 고프로락틴혈증, 그리고 졸림 등 부작용에 대하여 뛰어난 내약성을 가지는 것과 관련이 있을 것이다. 또한 약물 작용기전과 관련하여 신경영 양성인자 증가에 따른 신경가소성 활성화 및 D3 작용으로 인한 항우울제 작용, 그리고 D2 부분 효현 작용으로 인한 methylphenidate와 같은 각성 효과 등 치료효과도 기여하였을 것이다. 그리고 이러한 근거를 바탕으로 국내외의 대표적인 기분장애 약물치료 알고리듬 및 지침서에서 aripiprazole 등 비정형 항정신병약물이 주요한 치료전략으로 약진하는 등 최근의 학문적 발전 경향이 영향을 미쳤을 것으로 생각된다.

Objective Patterns of clinical use of aripiprazole have changed greatly in the past decade. We aimed to assess changes in these patterns in an inpatient unit at a university hospital between 2004-2008 and 2009-2013. Methods The subjects (n=182) were inpatients treated with aripiprazole between September 2004 and May 2013 who were categorized according to time period: Sep 2004-Dec 2008 (n=42) or Jan 2009-May 2013 (n=142). Aripiprazole was approved as an adjunctive therapy for patients with major depressive disorder by the Korea Food and Drug Administration in 2008. The subjects' charts were retrospectively reviewed to ascertain the distribution of psychiatric diagnoses and to identify other factors related to diagnosis, such as demographic characteristics, starting/maximum doses, and treatment regimen. Results Comparison of the two time periods showed that the most common psychiatric diagnoses changed from schizophrenia and other psychotic disorders to mood disorders such as major depressive disorder and bipolar disorder. Aripiprazole was more often prescribed for bipolar disorder, depressed patients during 2009-2013 than during 2004-2008 (15.5% vs. 2.4%, p=0.047). Patients with schizophrenia and other psychotic disorders (p=0.005), major depressive disorder (p=0.006), bipolar disorder, manic/mixed (p=0.006) and other diagnoses (p=0.029) had significantly lower starting doses during 2009-2013 than during 2004-2008. Although a trend was found toward a higher aripiprazole dose for schizophrenia and other psychotic disorders during 2009-2013 than during 2004-2008, the difference was not significant (28.3±1.4 vs. 22.1±2.1, p=0.061). Conclusion Treatment with aripiprazole has been extended beyond schizophrenia and other psychotic disorders to mood disorders and other diagnoses in clinical practice. The majority of patients treated with aripiprazole during the later period received lower starting doses than did those during the earlier one, although maximum doses varied depending on the psychiatric diagnosis.