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研究生:吳思霈
研究生(外文):Szu-Pei Wu
論文名稱:失智症老人使用抗精神病藥物及其死亡風險分析
論文名稱(外文):Antipsychotic Drug Use and Mortality Risk in Older Patients with Dementia
指導教授:吳肖琪吳肖琪引用關係
指導教授(外文):Shiao-Chi Wu
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:87
中文關鍵詞:失智症抗精神病藥物用藥率存活分析
外文關鍵詞:Dementiaantipsychotic drugprescription ratesurvival analysis
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背景:美國食品藥品管制局(FDA)2005年公告失智症老人使用「非典型」抗精神病藥物治療行為精神症狀,可能增加死亡風險。國外證實「典型」抗精神病藥物亦有安全疑慮。由於目前無替代藥物可治療失智症患者的行為精神症狀,臨床上使用抗精神病藥物治療行為精神症狀仍非常普遍。
目的:瞭解國內失智症老人抗精神病藥物用藥率,進而探討使用典型及非典型抗精神病藥物之影響因素以及用藥型態對180天內死亡情形。
方法:採回溯性世代研究(retrospective cohort study),利用2005年全民健康保險資料庫選取65歲以上失智症病人為對象,暸解其抗精神病藥物用藥率,並進一步針對新使用者探討使用典型及非典型藥物之影響因素及死亡情形。考慮到同一醫師看診之病患有聚集情形,因此使用GEE方法控制同一醫師診斷病人之相關性分析影響使用抗精神病藥物之相關因素;另以Cox迴歸分析不同型態抗精神病藥物對病人死亡之影響。
結果:國內2005年失智症老人共計83,701人,其使用非典型抗精神病藥物者為16.46%;典型抗精神病藥物為17.49%。使用典型抗精神病藥物受病患特質(年輕老人、用藥前住院)、就醫者醫療機構特質(私立醫院、醫學中心、精神科、神經內科)及醫師特質(年齡大)影響。使用典型抗精神病藥物的180天內死亡風險為非典型抗精神病藥物的1.25倍(95%CI: 1.09-1.43)。
結論:「典型」抗精神病藥物較「非典型」抗精神病藥物180天內死亡率高,臨床醫師在考量美國FDA對失智症病患治療的警告時,宜審慎評估使用抗精神病藥物之風險與效益。
Background: In April 2005, the Food and Drug Administration (FDA) issued an advisory stating that atypical antipsychotic medications increase mortality among elderly patients with dementia. Antipsychotic medications (APMs) are widely used to manage behavioral and psychological symptoms in dementia (BPSD) despite concerns about their safety.
Objective: To describe the use of conventional or atypical antipsychotics and examine the association between treatment with conventional or atypical antipsychotics and all-cause mortality.
Methods: The retrospective, cohort study used national data from the National Health Insurance (NHI) on patients with Dementia and older than 65 years to calculate prescription rates of atypical and conventional antipsychotic drugs. And then chose patients who began receiving a conventional or atypical APMs in 2005. Analyses of mortality rates and Cox proportional-hazards models were used to compare the risk of death within 180 days after the initiation of therapy with an antipsychotic medication.
Results: The study cohort included 83,701 patients. The prescription rate of atypical APMs was 16.46% and conventional APMs was 17.49%. Conventional APMs were associated with a significantly higher adjusted risk of death than were atypical APMs. (HR=1.25 ; 95%CI: 1.09-1.43)
Conclusion: Conventional APMs should not be used to replace atypical agents discontinued in response to the FDA warning.
第一章 研究緣起....................................... 1
第一節 研究背景....................................... 1
第二節 研究目的....................................... 2
第二章 文獻探討....................................... 3
第一節 失智症行為精神症狀之簡介....................... 3
第二節 抗精神病藥物之探討............................. 6
第三節 抗精神病藥物用藥率............................ 11
第四節 使用典型/非典型抗精神病藥物之影響因素探討......13
第五節 抗精神病藥物用藥型態影響死亡研究.............. 16
第三章 研究方法及步驟................................ 23
第一節 研究架構...................................... 23
第二節 資料來源與處理................................ 26
第三節 研究變項定義.................................. 30
第四節 資料分析方法.................................. 34
第四章研究結果....................................... 35
第一節 使用抗精神病藥物之情形........................ 38
第二節 典型/非典型抗精神病藥物之使用情形............. 40
第三節 影響使用典型/非典型抗精神病藥物之因素......... 44
第四節 抗精神病藥物用藥型態對病患死亡影響之情形...... 51
第五節 抗精神病藥物用藥型態對病患死亡影響之存活分析.. 57
第五章討論 ...........................................61
第一節 抗精神病藥物用藥率............................ 61
第二節 影響使用典型/非典型抗精神病藥物之因素......... 64
第三節 抗精神病藥物用藥型態對病患死亡影響之死亡情形.. 66
第四節 研究限制.......................................67
第六章結論與建議 .................................... 70
第一節 結論.......................................... 70
第二節 建議.......................................... 71
參考文獻............................................. 73
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