医生应用抗精神分裂症药物治疗的决策分析  

An analysis of medical decision making in antipsychotic drug choice for schizophrenia

作　　者：麦以成 何小林[2] 刘学兵 麦永煇 蔡教壁[3] 

机构地区：[1]佛山市顺德区伍仲佩纪念医院老年科,广东省佛山市533288 [2]广州市脑科医院精神科,广东省广州市510370 [3]佛山市第三人民医院门诊,广东省佛山市528041

出　　处：《中国临床康复》2005年第28期34-35,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:分析患者因素和医生因素对抗精神分裂症药物治疗的影响。方法:于2004-12在广州市脑科医院、顺德市伍仲佩纪念医院、佛山市第三人民医院访问120位精神科医生在治疗240例精神分裂症患者时的用药选择,用多元逻辑回归分析方法对数据进行分析。记录接受访谈的精神科医生的年龄,性别和工作年限。参加调查的医生进一步询问患者过去是否曾对某一种传统抗精神病药物治疗无效,是否表达过希望或拒绝使用某一类型的药物。并记录所有入选患者的年龄、性别、病程和住院次数,医生用阴阳性症状量表来评定患者的阴阳性症状,并评定患者的依从性(漏服药率<20%定义为依从,介于20%～80%为部分依从,>80%为不依从)。结果:纳入120位医生及240例患者均进入结果分析,无脱落者。①单变量比较,年龄大一点的患者,病程长的患者,或阴阳性症状量表评定阳性症状分值高的患者更可能被处方传统抗精神病药物,相反那些明确提出不想服用某一类型的药物或过去经传统抗精神病药物治疗疗效不佳,出现明显的副作用的患者更可能被处方非典型的新型抗精神病药物。医生方面:那些年资高的,临床经验相对丰富的或认为使用非典型的抗精神病药物费用太高的医生更倾向于处方传统抗精神病药物。②使用多元逻辑回归分析,医生的年龄(>50或<50岁)(OR=4.8,95%CI=1.1～11.3,P=0.006),依从性差(OR=3.8,95%CI=1.2～11.6,P<0.05),患者的病程(OR=1.1,95%CI=1.0～1.1,P<0.04)都会影响到患者对传统抗精神病药物的使用。只有医生的年龄会影响到传统抗精神病药物的使用(OR=4.7,95%CI=1.5～15.1,P=0.01)。结论:高年资的精神科医生倾向使用传统抗精神病药物。患者因素并没有明显影响医生的用药选择。有必要对精神科医生临床用药和处理患者的水平进行系统的观察和考证。AIM： To analyze the influences of patients and their physicians in the use of antipsychotic drug for schizophrenia.METHODS： In December 2004, an interview with 120 psychiatrists on drug choice for 240 patients suffering from schizophrenia was conducted in Guangzhou Brain Hospital, Shunde Wu Zhongpei Memorial Hospital and Foshan Third People＇s Hospital. Data were analyzed by using multiple logistic regression analysis. Age, sex and working lifetime of psychiatrists and age, sex, disease course and hospitalized times of patients were recorded. All the 240 patients were asked by the psychiatrists whether underwent an ineffectiveness of a traditional drug, and whether expressed the desire to accept or refuse a certain drug. Scale for assessment of positive and negative symptoms was used to assess the positive and negative symptoms of patients and their compliance by the psychiatrists.RESULTS： 120 psychiatrists and 240 patients were involved in the result analysis, and no one withdrew from the survey. ①Older patients or those with a longer disease course or obtaining a higher score on positive and negative symptoms were likely to be treated with traditional antipsychotic drugs, and those who definitely refused to accept a certain drug or underwent an ineffective treatment of traditional antipsychotic drugs with obvious ill effect were more likely to be treated with atypical new antipsychotic drugs. Older physicians possessing rich experience were more likely to prescribe first-generation antipsychotics. ②Multiple logistical regression analysis showed that psychiatrist＇s age （OR=4.8,95% CI=1.1-11.3;P=0.006）, worse compliance（OR=3.8, 95% CI=1.2-11.6,P 〈 0.05）, and course of disease （OR =1.1,95% CI=1.0-1.1,P 〈 0.04） could affect patients＇ choice of traditional antipsychotic drugs for schizophrenia. Only psychiatrists＇ age influenced treatment decision of traditional antipsychotic drugs.CONCLUSION： Psychiatrists with rich experience are likely to use traditional antipsychotic drugs and

关 键 词：精神分裂症 抗精神病药 回归分析 

分 类 号：R749.3[医药卫生—神经病学与精神病学]