조현병 환자에서 항우울제 사용 분석 : 임상적 관련인자 및 처방현황
Antidepressants Use in Schizophrenia : Clinical Correlates and Prescription Profiles
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Objectives To identify recent prescription patterns, as well as the demographic and clinical correlates of antidepressants (ADs) usage in schizophrenic patients. Methods A total of 297 patients diagnosed with schizophrenia enrolled at Seoul National Hospital in 2013. Brief Psychiatric Rating Scale (BPRS) was used to evaluate current psychiatric symptoms. Bivariate comparisons were used to assess the usage of concomitant psychotropics, demographic and clinical characteristics of ADs users compared with non-users. Multivariate analysis of covariance was performed consecutively. Results The rate of ADs usage was 26.3% and the most commonly used ADs were selective serotonin reuptake inhibitors. ADs users more often took benzodiazepine than ADs non-users (p=0.005), whereas there were no significant demographic and other clinical difference between the two groups. Regarding BPRS, somatic concern (p=0.022), anxiety (p=0.001) and depressive mood (p=0.009) scores were higher, and excitement (p=0.006) and hostility (p=0.04) scores were lower among ADs users compared to non-users, although there was no significant difference in the other scores of BPRS between the two groups. Moreover, among 5 components of BPRS, scores of affective symptoms (p<0.001) were significantly higher, and scores of activation symptoms (p=0.014) were significantly lower in ADs users compared to non-users. Conclusion This study suggests that the usage of ADs could be related to affective symptoms regardless of positive and negative symptoms of schizophrenia. Further studies are required in order to confirm the clinical correlates of ADs usage and the interactions between affective symptoms and psychotic symptoms.
Abstract
Objectives To identify recent prescription patterns, as well as the demographic and clinical correlates of antidepressants (ADs) usage in schizophrenic patients. Methods A total of 297 patients diagnosed with schizophrenia enrolled at Seoul National Hospital in 2013. Brief Psychiatric Rating Scale (BPRS) was used to evaluate current psychiatric symptoms. Bivariate comparisons were used to assess the usage of concomitant psychotropics, demographic and clinical characteristics of ADs users compared with non-users. Multivariate analysis of covariance was performed consecutively. Results The rate of ADs usage was 26.3% and the most commonly used ADs were selective serotonin reuptake inhibitors. ADs users more often took benzodiazepine than ADs non-users (p=0.005), whereas there were no significant demographic and other clinical difference between the two groups. Regarding BPRS, somatic concern (p=0.022), anxiety (p=0.001) and depressive mood (p=0.009) scores were higher, and excitement (p=0.006) and hostility (p=0.04) scores were lower among ADs users compared to non-users, although there was no significant difference in the other scores of BPRS between the two groups. Moreover, among 5 components of BPRS, scores of affective symptoms (p<0.001) were significantly higher, and scores of activation symptoms (p=0.014) were significantly lower in ADs users compared to non-users. Conclusion This study suggests that the usage of ADs could be related to affective symptoms regardless of positive and negative symptoms of schizophrenia. Further studies are required in order to confirm the clinical correlates of ADs usage and the interactions between affective symptoms and psychotic symptoms.
참고문헌 (35)
- Buckley PF, "Psychiatric comorbidities and schizophrenia", Schizophr Bull, 35, pp.383~402 (2009)
- Hausmann A, "Differential diagnosis of depressed mood in patients with schizophrenia: a diagnostic algorithm based on a review", Acta Psychiatr Scand, 106, pp.83~96 (2002)
- Mao YM, "Augmentation with antidepressants in schizophrenia treatment: benefit or risk", Neuropsychiatr Dis Treat, 11, pp.701~713 (2015)
- Hirsch SR, "Dysphoric and depressive symptoms in chronic schizophrenia", Schizophr Res, 2, pp.259~264 (1989)
- Koreen AR, "Depression in first-episode schizophrenia", Am J Psychiatry, 150, pp.1643~1648 (1993)
- Ritsner M, "Predictors of quality of life in major psychoses: a naturalistic followup study", J Clin Psychiatry, 64, pp.308~315 (2003)
- 정재훈, "정신분열병 입원환자의 우울증상 유병 률 및 예측인자", 생물치료정신의학, 17(1), pp.121~130 (2011), 대한생물치료정신의학회
- Jeon MS, "A study of depressive symptoms in schizophrenia", J Korean Neuropsychiatr Assoc, 20, pp.84~93 (1981)
- Häfner H, "Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia", Acta Psychiatr Scand, 100, pp.105~118 (1999)
- Birchwood M, "Psychological pathways to depression in schizophrenia: studies in acute psychosis, post psychotic depression and auditory hallucinations", Eur Arch Psychiatry Clin Neurosci, 255, pp.202~212 (2005)
- Micallef J, "Use of antidepressant drugs in schizophrenic patients with depression", Encephale, 32(2 Pt 1), pp.263~269 (2006)
- Jin H, "Association of depressive symptoms with worse functioning in schizophrenia:a study in older outpatients", J Clin Psychiatry, 62, pp.797~803 (2001)
- Conley RR, "The burden of depressive symptoms in the long-term treatment of patients with schizophrenia", Schizophr Res, 90, pp.186~197 (2007)
- Kay SR, "Pyramidical model of schizophrenia", Schizophr Bull, 16, pp.537~545 (1990)
- Siris SG, "Treating ‘depression’ in patients with schizophrenia: a thorough differential diagnosis determines the best treatment approach", Current Psychiatry, 11, pp.35~39 (2012)
- Lehman AF, "Practice guideline for the treatment of patients with schizophrenia, second edition", Am J Psychiatry, 161(2 Suppl), pp.1~56 (2004)
- Whitehead C, "Antidepressants for the treatment of depression in people with schizophrenia: a systematic review", Psychol Med, 33, pp.589~599 (2003)
- Farahani A, "Are antipsychotics or antidepressants needed for psychotic depression? A systematic review and meta-analysis of trials comparing antidepressant or antipsychotic monotherapy with combination treatment", J Clin Psychiatry, 73, pp.486~496 (2012)
- Buchanan RW, "Relationship of the use of adjunctive pharmacological agents to symptoms and level of function in schizophrenia", Am J Psychiatry, 159, pp.1035~1043 (2002)
- Lehman AF, "Patterns of usual care for schizophrenia:initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey", Schizophr Bull, 24, pp.11~20 (1998)
- Xiang YT, "Adjunctive antidepressant prescriptions for hospitalized patients with schizophrenia in Asia (2001-2009)", Asia Pac Psychiatry, 5, pp.E81~E87 (2013)
- American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. text revision", American Psychiatric Association, ~ (2000)
- Guy W, "ECDEU assessment manual for psychopharmacology" (1976), NIMH Psychopharmacology Research Branch
- Overall JE, "The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: I. Factor structure on an inpatient unit", J Gerontol, 39, pp.187~193 (1984)
- Shafer A, "Meta-analysis of the brief psychiatric rating scale factor structure", Psychol Assess, 17, pp.324~335 (2005)
- Simpson GM, "A rating scale for extrapyramidal side effects", Acta Psychiatr Scand, 212(Suppl), pp.11~19 (1970)
- Munetz MR, "How to examine patients using the Abnormal Involuntary Movement Scale", Hosp Community Psychiatry, 39, pp.1172~1177 (1988)
- Bianchi S, "Use of antipsychotic and antidepressant within the Psychiatric Disease Centre, Regional Health Service of Ferrara", BMC Clin Pharmacol, 11, pp.21~ (2011)
- Chakos MH, "Special section on CATIE baseline data: baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial", Psychiatr Serv, 57, pp.1094~1101 (2006)
- Siris SG, "Depression in schizophrenia: recognition and management in the USA", Schizophr Res, 47, pp.185~197 (2001)
- Englisch S, "Risks and benefits of bupropion treatment in schizophrenia: a systematic review of the current literature", Clin Neuropharmacol, 36, pp.203~215 (2013)
- Stahl SM, "Stahl’s essential psychopharmacology: neuroscientific basis and practical applications" (2013), Cambridge University Press
- Goldman RS, "Measurement of depression and negative symptoms in schizophrenia", Psychopathology, 25, pp.49~56 (1992)
- Addington D, "Specificity of the Calgary Depression Scale for schizophrenics", Schizophr Res, 11, pp.239~244 (1994)
- Reine G, "Depression and subjective quality of life in chronic phase schizophrenic patients", Acta Psychiatr Scand, 108, pp.297~303 (2003)