조현병 환자에서 항정신병약물 병용요법 분석 : 임상적관련인자 및 처방현황 조사
Clinical Correlates and Description Profiles of Antipsychotic Polypharmacy for Patients with Schizophrenia
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초록
2000년대 이후로 조현병 환자에게 더욱 다양한 약물 치료가 적용되고 있음에도 불구하고, 항정신병약물 병용요법과관련된 정신병리, 사회적 기능, 부작용 등 임상적인 모든 영역을 다루는 총체적인 연구 결과가 없는 상황이고, 현재의항정신병약물 병합요법의 처방 조합 및 경향에 대한 구체적자료가 필요한 시점이다. 본 연구는 국내 조현병 환자를 대상으로 병용요법군과 단독요법군의 사회 인구학적 자료와 CGI, BPRS, AIMS, SAS척도 점수를 비교 분석하였고, 최근 병합요법의 구체적인 처방 현황을 알아보았다. 연구결과, 항정신병약물 병합요법군은 단독요법군에 비해 BPRS 총점이 높았으며, 항목별 비교에서는 양성 증상, 정동 증상 세부 항목에서 점수가 유의하게높았다. 병합요법군은 단독요법군에 비해서 발병나이가 유의하게 어리고, CGI 점수가 유의하게 높았다. 또한 학력에차이가 없음에도 병용요법군에서 직업을 가진 비율이 유의하게 낮았다. 단독요법군에 비해서 병용요법군에서 항콜린성약제와 벤조다이아제핀계의 높은 처방률을 보여주었지만,MSQ로 측정한 약물만족도와 AIMS와 SAS로 평가한 약물부작용 비교 결과 두 군 간의 유의한 차이가 없었다. 가장 흔히 처방되는 항정신병약물 병합요법의 패턴은 두 가지 비정형 항정신병약물의 병합요법이었으며, 구체적 약물조합은risperidone-quetiapine으로 나타났다. 본 연구를 통해, 조현병 환자들은 정신증적 증상, 특히 양성 증상과 정동 증상이 심할수록 항정신병약물을 병용 처방받는 것으로 해석된다. 병용요법시 추체외로부작용이 증가되는 것으로 추정되나 부작용 조절약물을 통해 실제 부작용은 완화될 수 있으며, 환자들의 주관적 만족도도 단독요법을받는 환자들과 차이가 없음을 알 수 있었다. 또한, 항정신병약물 병용요법에서 비정형 항정신병약물의 비율이 증가하고 있음을 관찰할 수 있었다.
Abstract
Objectives Despite increasing use of antipsychotic polypharmacy (APP), few studies have investigatedAPP for Korean patients with schizophrenia. The aim of this study was to identify thesociodemographic and clinical correlates and recent prescription profiles of APP in schizophreniapatients. Methods A total of 297 schizophrenia patients were recruited and interviewed using standardizedassessment instruments in Seoul National Hospital. Differences in demographic and clinicalcharacteristics between APP and antipsychotic monopharmacy (APM) groups were analyzed. The prescriptions of psychotropic drugs were collected by a review of medical records. ResultsIn comparison with the APM group, the APP group showed association with earlieronset, lower employment rate, and higher scores for Clinical Global Impression-Severity andBrief Psychiatric Rating Scale (BPRS) (p<0.001). In particular, the BPRS positive (p<0.001) andaffective symptom scores (p<0.001) of the APP group were higher those of the APM group. Themost frequent combination pattern of APP was second generation antipsychotics (SGA)+SGA,followed by SGA+first generation antipsychotics (FGA), and SGA+SGA+FGA. For antipsychotics,it was risperidone+quetiapine, followed by clozapine+risperidone, risperidone+sulpiride, andrisperidone+haloperidol. Conclusion The current study suggests that the usage of APP for schizophrenia could be relatedto symptom severity affected by positive and affective symptoms. The prescription profilereflects that the proportion of atypical antipsychotics on APP has increased.
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