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일 종합병원에서 정신분열병과 분열정동장애를 진단받은 환자에서 항정신병약물의 1차 선택약물의 비율 및 1년 유지율에 관한 연구

The Study for the First-Drug Prescription Rate and Maintenance Rate of Antipsychotics in Patients who Developed(Were Diagnosed With) Schizophrenia and Schizoaffective Disorder in a General Hospital

최성진|조동환|김정기|서영익|장옥진|왕관수|제호준
대한생물치료정신의학회 (Korean Society Of Biological Therapies In Psychiatry)|2008.06|생물치료정신의학 (Journal of the Korean Society of Biological Therapies in Psychiatry)|제14권 제1호|pp. 49-57

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참고문헌

키워드

Schizophrenia정신분열병유지율항정신병약물AntipsychoticsMaintenance rate.
주제분류정신과학

초록

본 연구는 미리 통제되지 않은 자연스런 진료 상황에 서 정신분열병 환자들을 대상으로 항정신병 약물의 일 차 처방 빈도 및 1년 유지율을 조사하여 약물의 효과 를 간접적으로 조사하였다. 대부분의 환자들에서 atypic ¬al antipsychotics가 일차처방약물로 선택되어졌고, 1 년 유지율에서 typical antipsychotics가 더 높은 1년 유지율을 보였다. 이번 연구결과에서는 저자들의 예상 과는 달리 typical antipsychotics인 haloperidol이 제 일 높은 1년 유지율을 보였다. 그러나 typical antipsy ¬chotics를 처방받은 환자수가 상대적으로 적었기 때문 에 실제로 typical antipsychotics가 atypical antipsy ¬chotics에 비해 더 높은 1년 유지율을 보인다고 결론 지을 수는 없을 것이다. 따라서 이번 결과를 토대로 앞 으로 여러 기관들이 참여하는, 더 많은 환자들을 대상 으로 하는 연구가 시행되기를 기대한다.

Abstract

Objectives：This study was designed to evaluate prescription rate and indirectly the tolerability of antipsychotics using the maintenance rate for 1 year. The study was done in a situation where the patients who were diagnosed with either schizophrenia or schizoaffective disorder were given the antipsychotics and were looked into the pre¬scription rate and the state of use of drugs at first regardless of kind of drugs. Methods： This was a retrospective, naturalistic study using the data from medical record conducted in both in ¬patients and outpatients from January 1st in 2002 and June 30th in 2004 with a diagnosis of schizophrenia and schizoaffective disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were evaluated at 3, 6, 9, and 12th months after the onset of medication for the first-drug prescription rate and maintenance rate. Results：In total, 105 patients were recruited, and 40 out of 105 were male and 65 out of 105 were female. The mean age was 34.71 years old. The number of patients with schizophrenia was 94 and that of schizoaffective disorderwas 11. For the prescription rate of first drugs, of total risperidone was 56.2%；likely, 25.7% for olanzapine；10.5%for haloperidol；4.8% for quetiapine；and 2.9% for chlorpromazine. For 1-year maintenance rate, of total, haloperidolwas 45.5%；33.3% for chlorpromazine；22.0% for risperidone；14.8% for olanzapine；and 20.0% for quetiapine. Conclusion：Overall, atypical antipsychotics were far more prescribed than typical ones(86.7% and 13.3% for atypical and typical antipsychotics respectively). Although atypical antipsychotics were more prescribed than typical ones, the one-year maintenance rate was not higher than typical antipsychotics unlike our expectation that atypical antipsychotics would have better compliance and higher maintenance rate for 1 year under the circumstances with uncontrolled naturalistic conditions. There should be more statistical data available with larger sample size in the future.

참고문헌 (50)

  1. Hanns Hippius, "A historical perspective of clozapine", J Clin Psychiatry, (suppl), pp.S22~S23 (1999)
  2. Kane LM, "Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine", Arch Gen Psychiatry, 45, pp.789~796 (1988)
  3. Miller CH, "The Prevalence of acute extramidal sign and symptoms in patients treated with clozapine, risperidone, and conventional antipsychotics", L Clin Psychiatry, 59, pp.69~75 (1998)
  4. Cuesta MJ, "Effects of olanzapine and other antipsychotics on cognitive function in chronic schizophrenia: A longitudinal study", Schizophr Res, 48, pp.17~28 (2001)
  5. Glazer WM, "Extrapyramidal side effects, tardive dyskinesia, and the concept of atypicality", J Clin Psychiatry, 61(suppl 3), pp.S16~S21 (2000)
  6. Miller AL, "The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update", J Clin Psychiatry, 65, pp.500~508 (2004)
  7. Leucht S, "Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertidole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials", Schizophren Res, 35, pp.51~68 (1999)
  8. Davis JM, "A meta-analysis of the efficacy of second-generation antipsychotics", Arch Gen Psychiatry, 60, pp.553~564 (2003)
  9. Leucht S, "Relapse prevention in schizophrenia with new-generation antipsychotics: a systemic review and exploratory meta-analysis of randomized, controlled trials", Am J Psychiatry, 160, pp.1209~1222 (2003)
  10. Cramer JA, "Compliance with medication regimens for mental and physical disorders", Psychiatr Serv, 49, pp.196~201 (1998)
  11. Killaspy H, "Prospective controlled study of psychiatric outpatient non-attendance", Br J Psychiatry, 176, pp.160~165 (2001)
  12. Brekke JS, "Intensity and continuity of services and functional outcomes in the rehabilitation of persons with schizophrenia", Psychiatr Serv, 50, pp.248~256 (1999)
  13. Nose M, "How often do patients with psychosis fail to adhere to treatment programmes? A systematic review", Psychol Medicine, 33, pp.1149~1160 (2003)
  14. Simon AE, "Insight and its relationship to psychosocial adjustment in schizophrenia", J Nerv Ment Dis, 192, pp.442~445 (2004)
  15. Kampman O, "Compliance in psychoses", Acta Psychiatr Scand, 100, pp.167~175 (1999)
  16. Perkins DO, "Adherence to antipsychotic medications", J Clin Psychiatry, 60(Suppl 21), pp.S25~S30 (1999)
  17. Oehl M, "Compliance with antipsychotic treatment", Acta Psychiatr Scand, 102(Suppl 407), pp.S83~S86 (2000)
  18. Guttmacher MS, "Phenothiazine treatment in acute schizophrenia; effectiveness: The National Institute of Mental Health Psychopharmacology Service Center Collaborative Study Group", Arch Gen Psychiatry, 10, pp.246~261 (1964)
  19. Hegarty JD, "One hundred years of schizophrenia: a metaanalysis of the outcome literature", Am J Psychiatry, 151, pp.1409~1416 (1994)
  20. Kane JM, "Drug Therapy, Schizophrenia", N Engl J Med, pp.34~41 (2001)
  21. Kane JM, "Extrapyramidal side effects are unacceptable", EUR Neuropsychopharmacol, 11(Suppl 4), pp.S397~S403 (2001)
  22. Correll CU, "Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies", Am J Psychiatry, 161, pp.414~425 (2004)
  23. Dolder CR, "Antipsychotic medication adherence: is there a difference between typical and atypical agents", Am J Psychiatry, 159, pp.103~108 (2002)
  24. Naber D, "Good tolerability equals good results: the patient’s perspective", Eur Neuropsychopharmacol, 11(Suppl 4), pp.S391~S396 (2001)
  25. Kurzthaler I, "The clinical implications of weight gain in schizophrenia", J Clin Psychiatry, 62(Suppl 7), pp.S32~S37 (2001)
  26. Nasrallah HA, "Factors in antipsychotic drug selection: tolerability considerations", CNS Spectr, 811(Suppl 2), pp.S23~S25 (2003)
  27. May PR, "Schizophrenia: a follow-up study of the results of five forms of treatment", Arch Gen Psychiatry, 38, pp.776~784 (1981)
  28. Sheitman BB, "The evaluation and treatment of first-episode psychoses", Schizophr Bull, 23, pp.653~661 (1997)
  29. Robinson DG, "Predictor of treatment response from a first episode of schizophrenia or schizoaffective disorder", Am J Psychiatry, 156, pp.544~549 (1999)
  30. Lieberman JA, "The development of treatment resistance in patients with schizophrenia: a clinical and pathophysiological perspective", J Clin Psychopharmacol, 182(Suppl 1), pp.S20~S24 (1998)
  31. McEvoy JP, "Optimal dose of neuroleptic in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose", Arch Gen Psychiatry, 48, pp.739~745 (1991)
  32. Kane JM, "Low-dose neuroleptic treatment of outpatient schizophrenics, I:preliminary results for relapse rates", Arch Gen Psychiatry, 40, pp.893~896 (1983)
  33. Crow TJ, "A randomised controlled trial of prophylactic neuroleptic treatment", Br J Psychiatry, 148, pp.120~127 (1986)
  34. Tohen M, "The McLean first-episode psychosis project: six-month recovery and recurrence outcome", Schizophr Bull, 18, pp.172~185 (1992)
  35. Gitlin M, "Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia", Am J Psychiatry, 158, pp.1835~1842 (2001)
  36. Robinson D, "Predictors of relapse following response from a first episode of schizophrenia or Schizoaffective disorder", Arch Gen Psychiatry, 56, pp.241~247 (1999)
  37. Kinon BJ, "Mechanisms of action of atypical antipsychotic drugs: a critical analysis", Psychopharmacology(Berl), 124, pp.2~34 (1996)
  38. Leucht S, "Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo: a meta-analysis of randomized controlled trials", Schizophr Res, 35, pp.51~68 (1999)
  39. Geddes J, "Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis", Br Med J, 321, pp.1371~1376 (2000)
  40. Chakos M, "Effectiveness of second-generation antipsychotics on patients with treatment-resistant schizo phrenia: a review and meta-analysis of randomized trials", Am J psychiatry, 158, pp.518~526 (2001)
  41. Davis JM, "A meta-analysis of the efficacy of second-generation antipsychotics", Arch. Gen. Psychiatry, 60, pp.553~564 (2003)
  42. Sartorius N, "The usefulness and use of second generation antipsychotic medication", Curr. Opin. Psychiatry, 15(Suppl 1), pp.S1~S51 (2002)
  43. Sartorius, N, "The usefulness and use of second generation antipsychotic medication", Curr. Opin. Psychiatry, 16(Suppl 1), pp.S44~ (2003)
  44. Barnett D, "Guidance on the use of newer(atypical) antipsychotic drug for the treatment of schizophrenia" (2002), National Institute for Clinical Excellence(NICE). London
  45. Rosenheck R, "Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial", JAMA, 290, pp.2693~2702 (2003)
  46. Leucht S, "New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and metaanalysis", Lancet, 361, pp.1581~1589 (2003)
  47. Emsley RA(Risperidone Working Group), "Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study", Schizophr Bull, 25, pp.721~729 (1999)
  48. Sanger TM, "Olanzapine versus haloperidol treatment in first-episode psychosis", Am J Psychiatry, 156, pp.79~87 (1999)
  49. Lieberman JA, "Clinical antipsychotic Trials of Intervention Effectiveness(CATIE) Investigators: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia", N Engl J MED, 353, pp.1209~1223 (2005)
  50. Rosenheck RA, "Open forum: effectiveness versus efficacy of second-generation antipsychotics: haloperidol without anticholinergics as a comparator", Psychiatr Serv, 56, pp.85~92 (2005)

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