臺灣博碩士論文加值系統

目的：
自1990年代第二代抗精神病藥物陸續出現，與第一代抗精神病藥物相比，除了較低的錐體外路徑副作用發生率外，部分文獻指出，其較為有效或一樣有效，而且對於認知功能有明顯的改善，且社會功能也因而改善。但是，當醫師欲開立第二代抗精神病藥物時，如何選擇？本研究以過去病患實際使用不同抗精神病藥物之結果，建立資料庫，並進而建立精神分裂症病患使用第二代抗精神病藥物之臨床決策支援系統。
方法：
對象為桃園療養院醫療系統中，於民國91年1月1日至94年12月31日就診之病患資料，後續資料追蹤至95年12月31日止，其主診斷符合精神分裂症（含情感型精神分裂症）即予以納入，針對抗精神病藥物進行資料之彙整。以「持續服藥時間長短」作為整體指標，並蒐集個案之基本資料、過去疾病史、過去藥物治療史、、、等相關因子，以Cox proportional hazard model進行統計分析，找出有意義的因子，藉以建立臨床決策支援系統。
結果：
總計有3945位病患新開立抗精神病藥物，共有11085段「持續服藥期間」。其中使用第二代抗精神病藥物計有3005段，與使用第一代抗精神病藥物的個案相比，年齡較輕、過去住院次數、總日數較多、過去使用的抗精神病藥物種類數目較多，但卻有較少的中斷治療比例，以及較長的平均維持治療時間。就第二代抗精神病藥物間之比較，發現年齡、過去住院次數、過去使用第一代抗精神病藥物的種類數目、過去使用第二代抗精神病藥物的種類數目、前一抗精神病藥物使用之分類、先前藥物之治療日數、是否使用過risperidone、是否使用過olanzapine、是否使用過quetiapine、是否使用過clozapine等因子，對於持續治療時間具統計上之意義。以上述因子建立web介面之臨床決策支援系統。
結論：
透過「過去用藥紀錄查詢」子系統，可以立即迅速地得到個案之基本資料、疾病史、藥物治療史、、、等相關資料；再進入「第二代抗精神病藥物決策支援系統」子系統，將上述因子自動帶入，以圖、表之方式呈現：過去在資料庫當中具有類似情況之病患，使用了不同藥物之後，服用不同第二代抗精神病藥物之持續服藥情形，作為臨床決策之參考。

Objectives:
Compared with the first generation antipsychotics, the second generation antip-sychotics were not only less EPS-prone but also the same or more effective for treating schizophrenic patients. They also improved patients’ cognitive function and social function. How to choose between different second generation antip-sychotics? This study constructed a decision support system for prescribing second generation antipsychotics by previous prescription database in hospital information system.
Method:
The pharmacy-prescription database from Taoyuan mental hospital was used and it was further limited to outpatients with the diagnosis of schizophrenia or schi-zoaffective disorder by ICD-9-CM. All patients receiving antipsychotics be-tween 2002 and 2005 were defined as intend-to-treat populations and were fol-lowed for at least one year. Time to discontinuation was the primary outcome. Other factors such as geographic data, past hospitalization history, past drug history…etc were parametered into Cox proportional hazard model for analysis and they were the factors of decision support system.
Result:
Two subsystems were set up finally. The one was “Query for past history” and the other was “Decision support system for antipsychotics prescription”. Totally 11085 treatment episodes were identified during the study period. Age, hospi-talization history, prior use of first generation antipsychotics, prior use of second generation antipsychotics, the duration of prior drug treatment…were statisti-cally significant for time to discontinuation by using Cox proportional hazard regression model and they were used to construct “Decision support system for antipsychotics prescription” subsystem.
Conclusion:
Physicians could get all the information needed to make their decision on antip-sychotics prescription by “Query for past history” subsystem. “Decision support system for antipsychotics prescription” subsystem showed the possible out-comes in the same database after choosing different second generation antipsy-chotics. Both help in clinical setting.

標題
審定書
博碩士論文電子檔案上網授權書
誌謝 vi
目錄 vii
表目錄 x
圖目錄 xi
中文摘要 xiii
英文摘要 xv
第一章 緒論
1.1 精神分裂症之診斷、病程與治療 1
1.2 精神分裂症之藥物治療 2
1.3 使用第二代抗精神病藥物之規範 3
1.4 研究目的 4
第二章 文獻查證
2.1 抗精神病藥物之療效比較 6
2.2 選用抗精神病藥物之治療準則 8
2.3 不同第二代抗精神病藥物之比較 11
2.4 醫學資訊在精神分裂症治療之應用 12
第三章 研究材料與方法
3.1 研究對象 14
3.2 研究材料 15
3.3 研究工具 16
3.4 研究步驟 16
3.5 統計分析 24
第四章 分析與結果
4.1 系統介紹 26
4.2 過去用藥記錄查詢 27
4.3 抗精神病藥物持續使用比較 29
4.4 第二代抗精神病藥物使用之決策支援系統 43
4.5 系統滿意度評估 46
第五章 討論
5.1 過去用藥紀錄查詢 52
5.2 第二代抗精神病藥物使用之決策支援系統 56
5.3 本研究之限制 58
第六章 結論與建議 61
參考資料
中文文獻 63
英文文獻 63
電子資料 67

中文文獻
李明濱編著，《實用精神醫學，第二版》，台北：金名，民89.7。
沈武典著，《21世紀臨床精神藥物學，修訂版》，台北：合記，民93.2。
胡海國、林信男編著，《生物精神醫學》，台北：健康文化，民84.9。

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