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联合抗精神病药治疗重度抑郁发作的临床特征 和影响因素
王威史晓宁赵茜路亚洲张玲
0
()
摘要:
目的 对联合抗精神病药物(ATP)治疗的重度抑郁发作患者的临床特征和用药特点进行 分析和探讨。方法 回顾性分析于2013年12月~2016年11月在北京安定医院住院的共472例抑郁症 重度发作患者的临床资料,对联合或不联合ATP的重度抑郁发作患者人口学资料和病历特征进行比较。 结果 联合ATP的患者比例为56.3%(266/472),其中使用非典型抗精神病药物的患者占99.2%(264/266), 最常使用的药物是喹硫平、奥氮平和阿立哌唑。与未联合ATP组相比,联合ATP组患者年龄较轻(43岁比 50岁;Z=-2.908,P< 0.01),起病年龄较早[(38.9±13.4)岁比(35.4±13.0)岁;t=-2.822,P< 0.01],更多无 配偶(15.0%比26.7%;χ2=9.290,P< 0.01),更多伴有精神病性症状(3.9%比29.7%;χ2=51.461,P< 0.01), 更多使用心境稳定剂(4.4%比11.3%;χ2=7.311,P < 0.01),更多使用SSRI类药物(55.8%比68.8%; χ2=8.393,P< 0.01),以及住院时间更长(26 d比28 d;Z=-3.635,P< 0.01)。多元回归分析显示,伴精神 病性症状(OR=10.682,95%CI=4.948~23.064,P< 0.01),使用心境稳定剂(OR=3.054,95%CI=1.356~6.881, P < 0.01),无配偶(OR=0.545,95%CI=0.305~0.972,P < 0.05)等因素是联合ATP治疗抑郁症的影响因素。 结论 伴精神病性症状、接受心境稳定剂治疗、无配偶的抑郁症患者可能更多需要联合ATP进行治疗。 联合治疗的患者住院时间更长,疾病负担更重。
关键词:  抑郁症  抗精神病药  临床特征  影响因素
DOI:10.3969/j.issn.1009-6574.2017.12.003
基金项目:北京市科学技术委员会首都临床特色应用研究项目(Z141107002514033);北京市医院管理局“登峰”人 才培养计划项目(DFL20151801)
Clinical characteristics and influencing factors of antipsychotics augmentation for the treatment ofhospitalized patients with depressive disorder
()
Abstract:
Objective To analyze and explore the clinical characteristics and influencing factors of antipsychotics( ATP) augmentation for the treatment of severe major depression. Methods A retrospective analysis of clinical data was conducted among 472 patients with severe major depression who were admitted to Beijing Anding Hospital between December 2013 and November 2016. The data were concerned the demography and clinical characteristics to compare the differences between ATP augmentation group and non- ATP group. Results The proportion of ATP augmentation was 56.3%( 266/472), of which 99.2%( 264/266) patients received atypical antipsychotics augmentation treatment, and the most common used antipsychotic were quetiapine, olanzapine and aripiprazole. Compared to non-ATP group, the characteristics of ATP augmentation group were younger[ (43 vs 50) years old; Z=-2.908,P<0.01], with earlier illness onset age[ (38.9±13.4) vs (35.4±13.0)years old;t=-2.822,P<0.01], more single( 15.0% vs 26.7%;χ2=9.290, P<0.01), with higher psychotic symptoms rates( 3.9% vs 29.7%;χ2=51.461,P< 0.01), and with more mood stabilizers use( 4.4% vs 11.3%;χ2=7.311,P < 0.01), more selective serotonin reuptake inhibitors( SSRIs) use( 55.8% vs 68.8%; χ2=8.393, P < 0.01), as well as longer hospitalization days[(26 vs 28) d;Z=-3.635,P < 0.01)]. Logistic regression analysis demonstrated that psychotic symptoms( OR=10.682,95%CI=4.948-23.064,P<0.01), mood stabilizers use( OR=3.054, 95%CI=1.356-6.881,P<0.01), and no spouse( OR=0.545, 95%CI=0.305-0.972, P< 0.05) were the influencing factors of ATP augmentation. Conclusions Clinical psychiatrists trend to choose antipsychotic augmentation for the treatment of hospitalized depressive patients with the characteristics of with psychotic symptoms, current mood stabilizer use and no spouse. Those patients with ATP augmentation need longer hospitalization days, with heavier burden of disease.
Key words:  Depression  Antipsychotic  Clinical characteristics  Influencing factors

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