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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 高純琇 | |
dc.contributor.author | Tz-Mei Li | en |
dc.contributor.author | 李姿玫 | zh_TW |
dc.date.accessioned | 2021-06-08T05:16:03Z | - |
dc.date.copyright | 2006-02-10 | |
dc.date.issued | 2006 | |
dc.date.submitted | 2006-01-27 | |
dc.identifier.citation | 1. Schizophrenia and other psychotic disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV-TR) Washington, DC: American Psychiatric Association, 2000: 297- 319.
2. 行政院衛生署網站 www.doh.gov.tw/statistic/index.htm (2004.10) 3. Herz MI, Work Group on Schizophrenia, American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry 1997;154(suppl 4):1-63. 4. Lehman AF, Work Group on Schizophrenia, American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 2004;161(suppl 2):1-55. 5. Dixon LB, Lehman AF, Levine J. Conventional antipsychotic medications for schizophrenia. Schizophr Bull 1995;21:567-77. 6. Davis JM, Chen N, Glick ID. A meta-analysis of the efficacy of second-generation antipsychotics. Arch Gen Psychiatry 2003;60: 553-64. 7. Apiquian R,Fresan A, De Le Fuente-Sandoval C, et al. Survey on schizophrenia treatment in Mexico: Perception and antipsychotic prescription patterns. BMC Psychiatry 2004;4:12 8. Lieberman JA. Atypical antipsychotic drugs as a first-line treatment of schizophrenia: A rationale and hypothesis. J Clin Psychiatry 1996;57(suppl 11):68-71. 9. Canadian clinical practice guidelines for the treatment of schizophrenia. The Canadian Psychiatric Association. Can J Psychiatry 1998;43:25S-40S. 10. Frances A., Docherty JP, Kahn DA, et al. Treatment of schizophrenia, 1999.The expert consensus guideline series.1999; J Clin Psychiatry 1999;60 (suppl 11):3-80. 11. Miller AL, Chiles JA, Chiles JK, et al. The Texas Medication Algorithm Project (TMAP) schizophrenia algorithms. J Clin Psychiatry 1999;60:649- 57. 12. Essock SM. Editor’s introduction: Antipsychotic prescribing practices. Schizophr Bull 2002;28(1):1-4. 13. Weissman EM. Antipsychotic prescribing practices in the Veterans Healthcare Administration – New York Metropolitan region. Schizophr Bull 2002;28(1):31-42. 14. Hermann RC, Yang D, Ettner SL, et al. Prescription of antipsychotic drugs by office-based physicians in the United States, 1989-1997. Psychiatr Serv 2002;53(4):425-30. 15. Mond J, Morice R, Owen C, Korten A. Use of antipsychotic medications in Australia between July 1995 and December 2001. Aust N Z J Psychiatry 2003;37:55-61. 16. Trifiro G, Spina E, Brignoli O, et al. Antipsychotic prescribing pattern among Italian general practitioners: A population-based study during the years 1999-2002. Eur J Clin Pharmacol 2005. 17. 行政院衛生署網站 www.doh.gov.tw/statistic/data/全民健康保險重要統計資料/承保業務.xls (2004.12) 18. Su TP, Chen TJ, Hwang SJ, et al. Utilization of psychotropic drugs in Taiwan: An overview of outpatient sector in 2000. Chinese Med J (Taipei) 2002;65: 378-91. 19. Chou LF. Patterns and costs of antipsychotic drug use in Taiwan: 1997 to 2001.Adv Ther 2003;20(6):344-51. 20. Crismon ML, Dorson PG. Schizophrenia. In: Dipiro JT, Talbert RL, Yee GC, Marzke GR, Wells BG, Prosey Lm, editors. Pharmacotherapy: A pathophysiologic approach. 5th ed. New York: McGraw-Hill; 2002. 21. Lacro JP. Schizophrenia. In: Koda-Kinble MA, Young LY, Kadjan WA, Guglielmo BJ, editors. Applied therapeutics: The clinical use of drugs. 8th ed. Philadelphia: Lippinocott Williams and Wilkins; 2004. 22. Karasu T, Waltzman S, Lindenmayer JP, et al. The medical care of patients with psychiatric illness. Hosp Community Psychiatry 1980;31:463-71. 23. Bland RC, Parker JH, Orn H. Prognosis in schizophrenia: A ten-year follow-up of first admission. Arch Gen Psychiatry 1976;33: 949-54. 24. Tsuang MT, Woolson RF. Mortality in patients with schizophrenia, mania, depression and surgical conditions; A comparison with general population mortality. Br J Psychiatry 1977;130:162-6. 25. Tsuang MT, Woolson RF. Excess mortality in schizophrenia and affective disorders: Do suicides and accidental death solely account for this excess? Arch Gen Psychiatry 1978;35:1181-5. 26. Tsuang MT, Woolson RF, Fleming JA. Causes of death in schizophrenia and manic-depression. Br J Psychiatry 1980;136: 239-42. 27. Tsuang MT, Woolson RF, Fleming JA. Premature deaths in schizophrenia and affective disorders: An analysis of survival curves and variables affecting the shortened survival. Arch Gen Psychiatry 1980;37:979-83. 28. Tsuang MT. Suicide in schizophrenics, manics, depressives, and surgical controls: A comparison with general population suecide mortality. Arch Gen Psychiatry 1978;35:153-5. 29. McGlashan TH. A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophr Bull 1988;14:515-42. 30. Docherty NM, DeRosa M, Andreasen NC. Communication disturbances in schizophrenia and mania. Arch Gen Psychiatry 1996;53:358-64. 31. McGlashan TH, Fenton WS. The positive/negative distinction in schizophrenia: Review of natural history validators. Arch Gen Psychiatry 1992;49:63-72. 32. Kane JM. Schizophrenia. N Engl J Med 1996;334:34-41. 33. Andreasen NC. Schizophrenia: The fundamental questions. Brain Res Brain Res Rev 2000;31:106-12. 34. Huber G, Gross G, Schuttler R, et al. Longitudinal studies of schizophrenic patients. Schizophr Bull 1980;6:592-605. 35. Ciompi L. The natural history of schizophrenia in the long term. Br J Psychiatry 1980;136:413-20. 36. Ciompi L. Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophr Bull 1980;6:608-18. 37. McGlashan TH, Fenton WS. Subtype progression and pathophysiologic deterioration in early schizophrenia. Schizophr Bull 1993;19:71-84. 38. Regier DA, Myers JK, Kramer M, et al. The NIMH Epidemiologic Catchment Area program: Historical context, major objectives, and study population characteristics. Arch Gen Psychiatry 1984: 41:934-41. 39. Robins LN, Helzer JE, Weissman MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 1984;41:949-58. 40. Wyatt RJ, Alexander RC, Egan MF, et al. Schizophrenia: Just the facts. Schizophr Res 1988;1:3-18. 41. 中華民國台灣地區2002全民健保主要疾病就診率統計。行政院衛生署編印, 2004年三月出版. 42. Kendler KS, Diehl SR. The genetics of schizophrenia: A current genetic-epidemiologic perspective. Schizophr Bull 1998;19: 261-85. 43. Ereshefsky L, Tran-Johnson TK, Watanabe MD. Pathophysiologic basis for schizophrenia and the efficacy of antipsychotics. Clin Pharm 1990;9:682- 707. 44. Goldman-Rakic PS, Selemon LD. Functional and anatomical aspects of prefrontal pathology in schizophrenia. Schizophr Bull 1997; 23:437-58. 45. Lieberman JA, Koreen AR. Neurochemistry and neuroendocrinology of schizophrenia: A selective review. In: Shore D, ed. Schizophrenia 1993. Rockville, MD, National Institute of Mental Health, 1993:197-255. 46. Henn FA. The NMDA receptor as a site for psychopathology. Primary or secondary role? Arch Gen Psychiatry 1995;52:1008-10. 47. Holoman LC, Marder SR. Management of acute extrapyramidal effects induced by antipsychotic drugs. Am J Health Syst Pharm 1997; 54:2461-77. 48. Guze BH, Baxter Jr LR. Neuroleptic malignant syndrome. N Engl J Med 1985;31:163-6. 49. Simpson GM, Pi EH, Sramek JJ. Adverse effects of AP agents. Drugs 1981; 21:138-51. 50. Sullivan G, Lukoff D. Sexual side effects of AP medication: Evaluation and interventions. Hosp Community Psychiatry 1990; 41:1238-41. 51. Kapur S, Zipursky RB, Remington G. Clinical and theoretical implications of 5-HT2 and D2 receptor occupancy of clozapine, risperidone, and olanzapine in schizophrenia. Am J Psychiatry 1999;156:286-93. 52. Alvir JMJ, Lieberman JA, Safferman AZ, et al. Clozapine-induced agranulocytosis: Incidence and risk factors in the United States. N Engl J Med 1993;329:162-7. 53. Lieberman JA, Johns CA,Kane JM, et al. Clozapine-induced agranulocytosis: non-cross-reactivity with other psychotropic drugs. J Clin Psychiatry 1988;49:271-7. 54. Allison DB, Mentore JL, Heo M, et al. Antipsychotic-induced weight gain: A comprehensive research synthesis. Am J Psychiatry 1999;156:1686-96. 55. Henderson DC, Cagliero E, Gray C, et al. Clozapine, diabetes mellitus, weight gain and lipid abnormalities: A five-year naturalistic study. Am J Psychiatry 2000;157:975-81. 56. Fink M, Sackeim HA: Convulsive therapy in schizophrenia? Schizophr Bull 1996;22:27-39. 57. Swoboda E, Conca A, Konig P, et al. Maintenance electroconvulsive therapy in affective and schizoaffective disorder. Neuropsychobiology 2001;43:23-8. 58. Chanpattana W, Chakrabhand ML, Sackeim HA, et al. Continuation ECT in treatment-resistant schizophrenia: A controlled study. J ECT 1999;15:178-92. 59. Klapheke MM. Electroconvulsive therapy consultation: An update. Convuls Ther 1997;13:227-41. 60. Cook JA, Razzano L. Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice. Schizophr Bull 2000;26:87-103. 61. Dixon L, Adams C, Lucksted A. Update on family psychoeducation for schizophrenia. Schizophr Bull 2000;26:5-20. 62. Jaffe AB, Levine J. Efficacy and effectiveness of first- and second-generation antipsychotics in schizophrenia. J Clin Psychiatry 2003;64(suppl 17):3-6. 63. Glazer WM, Kane JM. Depot neuroleptic therapy: An underutilized treatment option. J Clin Psychiatry 1992;53:426-33. 64. Adams CE, Fenton MKP, Quraishi S, et al. Systematic meta-review of depot antipsychotic drugs for people with schizophrenia. Br J Psychiatry 2001;179: 290-9. 65. Kane JM, Honigfeld G, Singer J, et al. Clozapine for the treatment -resistant schizophrenic: A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789-96. 66. 美國藥物食品管理局網站www.fda.gov/medwatch/SAFETY/2003/03DEC_PI/clozaril_PI.pdf (2004.12) 67. 行政院衛生署網站 www.nhi.gov.tw/07information/bulletin_file/121_93年5月版給付規定 (2004.10) 68. Copolov DL, Bell WR, Benson WJ, et al. Clozapine treatment in Australia: a review of haematological monitoring. MJA 1998;168: 495-7. 69. Clozaril〔package insert〕. West Sussex, UK: Novartis Pharmaceuticals Corp; 2004. 70. Peacock L, Solgaard T, Lublin H, et al. Clozapine versus typical antipsychotics: a retro- and prospective study of extrapyramidal side effect. Psychopharmacology (Berl) 1996;124:188-196. 71. Sebastian CS, Glazer W, Buckley PF. Naturalistic studies of second generation antipsychotics in the treatment of schizophrenia. Curr Med Chem 2004;11:329-42. 72. Lambert M, Conus P, Eide P, et al. Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence. Eur Psychiatry 2004;19: 415-22. 73. Kapur S, Seaman S. Does fast dissociation from the dopamine D2 receptor explain the action of atypical antipsychotics: A new hypothesis. Am J Psychiatry 2001;158:360-96. 74. Gazdag G, Kocsis N, Lipcsey A, et al. Rates of electroconvulsive therapy use in Hungary in 2002. J ECT 2004;20:42-4. 75. McCall WV. Electroconvulsive therapy in the era of modern psychopharmacology. Int J Neuropsychopharmacol 2001;4:315-24. 76. Clark RE, Bartels SJ, Mellman TA, et al. Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications from state mental health policy. Schizophr Bull 2002;28:75-84. 77. Miller AL, Craig CS. Combination antipsychotics: Pros, cons, and questions. Schizophr Bull 2002;28:105-9. 78. Stahl SM. Antipsychotic polypharmacy, part 1: Therapeutic option or dirty little secret? J Clin Psychiatry 1999;60:425-6. 79. Canales PL, Olsen J, Miller AL, et al. Role of antipsychotic polypharmacotherapy in the treatment of schizophrenia.CNS Drugs 1999;12: 179-88. 80. Stiloh R, Zemishlany Z, Aizenberg D, et al. Sulpiride augmentation in people with schizophrenia partially responsive to clozapine. A double-blind, placebo-controlled study. Br J Psychiatry 1997; 171:569-73. 81. Reinstein MJ, Sirotovskaya LA, Jones LE, et al. Effect of clozapine- quetiapine combination therapy on weight gain and glycaemic control. Clin Drug Invest 1999;18:99-104. 82. Covell NH, Jackson CT, Evans AC, et al. Antipsychotic prescribing practices in Connecticut’s public mental health system: Rate of changing medications and prescribing styles. Schizophr Bull 2002;28:17-29. 83. Ganguly R, Kotzan JA, Miller LS, et al. Prevalence, trends, and factors associated with antipsychotic polypharmacy among Medicaid-eligible schizophrenia patients,1998-2000. J Clin Psychiatry 2004;65:1377-88. 84. Edlinger M, Baumgartner S, Eltanaihi-Furtmiiller N, et al. Switching between second-generation antipsychotics. Why and How ? CNS Drugs 2005; 19:27-42. 85. Meltzer HY, Lee MA, Cola P. The evolution of treatment resistance: biologic implications. J Clin Psychopharmacol 1998;18 (Suppl. 1): 5-11. 86. Kane JM, Borenstein M. Compliance in the long-term treatment of schizophrenia. Psychopharmacol Bull 1985;21:23-7. 87. Weiden PJ, Aquila R, Dalheim L, et al. Switching antipsychotic medications. J Clin Psychiatry 1997;58(Suppl.10):63-72. 88. Ganguli R. Rationale and strategies for switching antipsychotics. Am J Health Syst Pharm 2002;59(Suppl.8):S22-6. 89. Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am J Psychiatry 1995;152:183-90. 90. Taylor DM, Young C, Paton C. Prior antipsychotic prescribing in patients currently receiving clozapine: A case note review. J Clin Psychiatry 2003;64: 30-4. 91. Hodgson R, Belgamwar R, Al-tawarah Y, et al. The use of atypical antipsychotics in the treatment of schizophrenia in North Staffordshire. Hum Psychopharmacol Clin Exp 2005;20:141-7. 92. Conley RR, Tamminga CA, Kelly DL, et al. Treatment-resistant schizophrenic patients respond to clozapine after olanzapine non-response. Biol Psychiatry 1999;46:73-7. 93. Still DJ, Dorson PG, Crismon ML, et al. Effects of switching inpatients with treatment-resistant schizophrenia from clozapine to risperidone. Psychiatr Serv 1996;47:1382-4. 94. Henderson DC, Nasrallah RA, Goff DC. Switching from clozapine to olanzapine in treatment-refractory schizophrenia: Safety, clinical efficacy, and predictors of response. J Clin Psychiatry 1998;59: 585- 8. 95. Littrel KH, Johnson CG, Hilligoss NM, et al. Switching clozapine responders to olanzapine. J Clin Psychiatry 2000;61:912-5. 96. Dossenbach MRK, Beuzen JN, Avnon M, et al. The effectiveness of olanzapine in treatment-refractory schizophrenia when patients are nonresponsive to or unable to tolerate clozapine. Clin Ther 2000;22:1021-34. 97. 世界衛生組織網站 www.whocc.no/atcddd/atcsystem.html (2004.12) 98. 國家衛生研究院網站 www.nhri.org.tw/nhird/file_talk/psy_document.pdf (2004.10) 99. MICROMEDEX (R) Healthcare Series ﹝computer program﹞volume 124. USA Thomson. Micromedex; 2004. 100.行政院衛生署網站 www.nhi.gov.tw/06inquire/query2_list.asp (2005.4) 101. Hermann RC, Dorwatt RA, Hoover CW, et al. Variation in ECT use in the United States. Am J Psychiatry 1995;152:869-75. 102. Tapp A, Wood AE, Secrest L, et al. Combination antipsychotic therapy in clinical practice. Psychiatr Serv 2003;54:55-9. 103. Kane JM, Leucht S, Carpenter D, et al. The Expert consensus guideline series optimizing pharmacologic treatment of psychotic disorders. J Clin Psychiatry 2003;64 (suppl.12):1-97. 104. National Institute for Clinical Excellence. Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. The Appraisal Committee. NICE Technology Appraisal Guidance 2002;43:1-20. 105. Zhang M, Owen RR, Pope SK, et al. Cost-effectiveness of clozapine monitoring after the first 6 months. Arch Gen Psychiatry 1996; 53:954-8. 106. Alphs LD, Anand R. Clozapine: the commitment to patient safety. J Clin Psychiatry 1999;60(suppl 12):39-42. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/24106 | - |
dc.description.abstract | 研究背景:
使用抗精神分裂藥物是精神分裂疾病最重要的治療方法之一,藥物的效果主要是控制和減少急性期的症狀以及預防疾病的復發。相對於傳統第一代抗精神分裂藥物,第二代抗精神分裂藥物不僅有較少外椎體系統的副作用,更可改善認知功能並對負性症狀具有療效。因此隨著第二代抗精神分裂藥物在台灣陸續上市,對於精神分裂疾病之處方型態,預期會有重大的改變及影響。 研究目的: 1. 建立1997年至2001年國內關於曾住院之精神分裂病患使用抗精神分裂藥物的描述性資料,分析五年來用藥類型的改變和趨勢,以及各型態和各層級醫療機構的用藥趨勢。 2. 分析1997年至2001年門診及住院病人處方中,抗精神分裂藥物多重用藥之情形。 3. 探討於1998年至2003年間第一次使用clozapine的病人,其轉換用藥之情形。 研究方法: 取『精神疾病住院病患歸人檔(Psychiatric Inpatient Medical Claim Dataset ; PIMC)』資料庫,選出1996年至2001年住院主診斷或次診斷曾出現295.xx診斷碼者之病人,得到其1997年至2003年所有門診及住院就醫資料。而後取用藥時年齡為18至65歲之患者,利用門診健保申報資料中的藥品使用頻率和用量,以及世界衛生組織所公佈的defined daily dose (DDD),計算每一抗精神分裂藥物的使用天數,門診處方之藥物的使用天數大於7天或當年度同一病人使用該藥物兩次以上,或同次住院期間抗精神分裂藥物的使用天數大於7天時,則將該筆資料納入分析。統計分析方法主要使用SAS 8.2版進行描述性統計分析。 結果: 自1997年至2001年間,符合用藥限制條件者共計46,312人,其中男性有26,656人,女性有19,656人。 1.自1997年至2001年,每年使用最多的抗精神分裂藥物為 sulpiride ,其次則為haloperidol。五年來抗精神分裂藥物的使用趨勢,典型抗精神分裂藥物逐年減少,使用人次比例由94.6%降至73.0%(β=-0.43,p<0.0001),clozapine和非典型抗精神分裂藥物則逐年增加,其中clozapine的使用人次比例由4.6%增加至10.9%(β=0.25,p=0.0501),而其他非典型抗精神分裂藥物的使用人次比例,由0.8%增加至16.1%(β=0.62,p<0.0001)。另外,自1997年至2001年,典型抗精神分裂藥物在各型態醫療機構的使用有逐年減少的趨勢,其中使用人次比例以在“綜合醫院”型態醫療機構減少的幅度最大(β=-0.50,p<0.0001),約減少29%。而非典型抗精神分裂藥物在各型態醫療機構的使用皆有逐年增加的趨勢,使用人次比例同樣以在“綜合醫院”型態醫療機構增加的幅度最大(β=0.63,p<0.0001),增加約111倍。至於clozapine的使用,在各型態醫療機構的使用也有逐年增加的趨勢,使用人次比例增加的幅度則以在“其他”型態醫療機構為最大(β=0.38,p=0.0811),約增加2.5倍。自1997年至2001年,典型抗精神分裂藥物在各層級醫療機構的使用有逐年減少的趨勢,使用人次比例減少的幅度以在“醫學中心”層級醫療機構為最大(β= -0.55,p<0.0001),約減少38%。非典型抗精神分裂藥物在各層級醫療機構的使用,則有逐年增加的趨勢,使用人次比例增加的幅度,以在“醫學中心”層級醫療機構為最大(β=0.7,p<0.0001),約增加了311倍。而clozapine在各層級醫療機構的使用也有逐年增加的趨勢,使用人次比例增加的幅度,則以在“其他”層級醫療機構為最大(β=0.46,p=0.0477),約增加了3.8倍。 2.從1997年至2001年五年間,住院申報資料中,單一用藥的申報人次比例逐年增加(β=0.20,p=0.0046),而多重用藥的申報人次比例(β= -0.20,p=0.0046)則逐年減少。門診就醫資料中,單一用藥的使用人次逐年增加(β=0.21,p=0.0053),而多重用藥的使用人次比例則逐年減少(β= -0.21,p=0.0053)。 3.1998年至2003年第一次使用clozapine治療前一年內,曾以典型抗精神分裂藥物,或非典型抗精神分裂藥物做過適當治療的病人中(7,509人),有53.2%只使用過典型抗精神分裂藥物,5.4%只使用過非典型抗精神分裂藥物,其餘的41.4%使用過典型抗精神分裂藥物和非典型抗精神分裂藥物。而在使用clozapine治療後,有44.3%的病人持續以clozapine治療, 36.7%轉換成以典型抗精神分裂藥物治療,其餘的19.0%則轉換成以非典型抗精神分裂藥物治療。另外,在血液監測方面,1998-2003年第一次使用clozapine治療的病人(8,367人)中,有12.5%病人在使用clozapine後沒有作過任何血液檢查,而且只有3.2%的病人接近平均每週抽血檢查一次。 結論: 研究結果顯示,自1997年至2001年,隨著非典型抗精神分裂藥物在台灣陸續上市,典型抗精神分裂藥物的使用有逐年減少的趨勢,非典型抗精神分裂藥物的使用則是逐年增加。而多重用藥的使用,不論是使用於門診病人或住院病人,則有逐年減少的趨勢。另外,從1998年至2003年使用過clozapine的病人中,有89.7%的病人在第一次使用clozapine治療前一年內,曾經接受過適當的藥物治療,其中有46.8%的病人曾接受過非典型抗精神分裂藥物的治療。而在clozapine血液方面副作用的監測,由研究結果可以得知,臨床上的執行仍不夠確實,有12.5%的病人在使用clozapine後,未接受過血液檢查,值得深切注意。 | zh_TW |
dc.description.abstract | Background
Pharmacotherapy is one of the most important treatments of schizophrenia. The effects of antipsychotic drugs are mainly symptom control and prevention of relapse. In contrast to conventional typical antipsychotic drugs, atypical antipsychotic drugs not only cause fewer extrapyramidal side effects, but also improve cognitive function and negative symptoms. With the emergence of atypical antipsychotics, the change on the prescribing pattern of schizophrenia is expected. The objectives of this study are to analyse the utilization of the antipsychotic agents in Taiwan from 1997 to 2001, to assess the polypharmacy in antipsychotic agents on the prescriptions of outpatients and inpatients, and to explore the drug switching pattern before and after the use of clozapine during the years 1998-2003. Methods The sampling datasets from the Psychiatric Inpatient Medical Claim Dataset (PIMC) served as data sources. The patients with the primary or the secondary diagnosis of 295.xx on admission to hospital during 1996-2001 and with the age greater than 18 years were included. The measurement units used for calculating prescription day of inpatients’ antipsychotic drugs were the defined daily doses published by WHO. The inclusion criteria of antipsychotic drug user were : 1. prescription days greater than 7 days or who had ≧ 2 outpatient prescriptions in one year. 2. prescription day greater than 7 days for each inpatient admission. SAS 8.2 database software was used for data linkage and processing. Results After data exclusion, medical records of 46,312 patients (male: 26,656, female: 19,656) during the years 1997-2001 were collected for this study. 1. Medication trend: based on prescription number counting, most utilized antipsychotic drug was sulpiride, followed by haloperidol from 1997 to 2001. During the five years, the utilization of typical antipsychotics was gradually decreased (β= -0.43,p<0.0001), however, the use of atypical antipsychotic (except clozapine) was continuously increased (β=0.62,p<0.0001). The use of clozapine was also increased (β=0.25,p=0.0501). 2. Polypharmacy: among inpatients, the frequency of antipsychiatric agent monotherapy was increased yearly (β=0.20,p=0.0046), and the frequency of polypharmacy decreased (β=-0.20,p=0.0046) from 1997 to 2001. Among outpatients, the frequency of monotherapy use also increased (β=0.21,p=0.0053), and the frequency of polypharmacy use decreased (β=-0.21,p=0.0053) from 1997 to 2001. 3. Clozapine switching and monitoring: during 1998-2003, before initiation of clozapine, 53.2% patients had been treated with typical antipsychotics alone, 5.4% patients had been treated with atypical antipsychotics alone , and 41.4% patients were treated with both typical and atypical antipsychotics. After clozapine therapy, 44.3% patients use clozapine continuously, 36.7% patients were switched to typical antipsychotics, and 19% patients were switched to the other atypical antipsychotics. Among the those who initiate of clozapine during 1998-2003, 12.5% patients had no blood test claim data after using clozapine, and only 3.2% patients had blood monitoring weekly. Conclusions Findings from this study indicated that the prescribing patterns of schizophrenia in Taiwan from 1997 to 2001 were changed. The utilization of typical antipsychotics decreased, and the use of atypical antipsychotics increased gradually. Although polypharmacy of antipsychotic agents was debatable, the trend of polypharmacy use was decreased gradually. Among the first users of clozapine during 1998-2003, 46.8% patients have used atypical antipsychotics as their appropriate therapy. And 12.5% patients had no blood test claim data after clozapine therapy. | en |
dc.description.provenance | Made available in DSpace on 2021-06-08T05:16:03Z (GMT). No. of bitstreams: 1 ntu-95-R91451006-1.pdf: 820152 bytes, checksum: 7e7cf22428e3effd257aeba45db969e0 (MD5) Previous issue date: 2006 | en |
dc.description.tableofcontents | 中文摘要…………………………………………………………Ⅰ
ABSTRACT…………………………………………………………Ⅵ 目錄………………………………………………………………Ⅸ 圖目錄……………………………………………………………XII 表目錄……………………………………………………………ⅩⅤ 第一章 前言………………………………………………………1 第二章 文獻探討……………………………………………………4 第一節 精神分裂症 Schizophrenia………………………………4 一、 精神分裂症的診斷…………………………………………4 二、 精神分裂症的臨床症狀與病程……………………………4 三、 精神分裂症的盛行率………………………………………6 四、 精神分裂症的病因學………………………………………7 五、 精神分裂症的治療…………………………………………8 第二節 精神分裂症治療型態………………………………………12 一、 藥物治療……………………………………………………12 二、 電痙攣治療…………………………………………………14 三、 治療型態逐年趨勢…………………………………………14 第三節 多重用藥……………………………………………………19 第四節 藥物轉換……………………………………………………23 第五節 ATC/DDD系統………………………………………………28 第三章 研究目的……………………………………………………30 第四章 研究方法……………………………………………………31 第一節 資料收集及定義……………………………………………31 第二節 資料分析……………………………………………………41 一、 治療形式之趨勢分析………………………………………41 二、 多重用藥……………………………………………………43 三、 藥物轉換……………………………………………………45 第三節 資料處理與分析……………………………………………50 第五章 研究結果……………………………………………………51 第一節 研究族群……………………………………………………51 第二節 抗精神分裂藥物使用分析…………………………………55 一、 抗精神分裂藥物使用趨勢…………………………………55 二、 依醫療機構分析抗精神分裂藥物的使用…………………73 第三節 本研究病人群之電痙攣療法使用情形……………………89 第四節 多重用藥……………………………………………………93 第五節 藥物轉換分析……………………………………………111 一、 病人族群之分析…………………………………………111 二、 第一次使用clozapine前使用情形之分析………………114 三、 轉換使用clozapine治療後病人之用藥情形……………116 四、 第一次使用clozapine治療的病人血液監測之情形……117 第六章 討論………………………………………………………125 第一節 抗精神分裂藥物使用趨勢………………………………125 第二節 電痙攣療法的使用………………………………………129 第三節 多重用藥…………………………………………………130 第四節 藥物轉換…………………………………………………135 第五節 研究限制…………………………………………………142 第七章 結論………………………………………………………144 參考文獻………………………………………………………………146 | |
dc.language.iso | zh-TW | |
dc.title | 台灣抗精神分裂藥物之處方型態--健保資料庫精神疾病住院病患歸人檔之分析 | zh_TW |
dc.title | Prescribing patterns of antipsychotic drugs in Taiwan
-- Analysis of Psychiatric Inpatient Medical Claim dataset | en |
dc.type | Thesis | |
dc.date.schoolyear | 94-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 林慧玲,高淑芬,張景瑞 | |
dc.subject.keyword | 抗精神分裂藥物,處方型態,健保資料庫, | zh_TW |
dc.subject.keyword | antipsychotic drugs,prescribing pattern,drug switching, | en |
dc.relation.page | 153 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2006-01-27 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
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