양극성장애 입원 환자에서 약물 사용의 변화: 일 대학병원에서 1998~2001년과 2009~2012년의 비교 = A Trend of Drug Use in Inpatients with Bipolar Disorder: Comparing 2009-2012 with 1998-2001 in One University Hospital

다국어 초록 (Multilingual Abstract)

ObjectivezzThe aim of this study was to monitor changes of prescription trends for bipolar disorder in inpatient settings in one university hospital.
MethodszzA retrospective chart review was performed and data of 188 cases (2009–2012) and 118 cases (1998–2001) with a diagnosis of bipolar disorder were collected. Data on demographic variables, duration of hospitalization, kinds of psychotropic medications and the patterns of prescription over each four-year period were analyzed.
ResultszzThe proportion of patients with manic episode was decreased, whereas those of mixed and depressive episodes were increased. The use of lithium was decreased with the increased use of valproate. Increased use of lamotrigine in depressive episode was prominent. The use of combination treatment with mood stabilizers and antipsychotics was almost same level in both periods. The use of typical antipsychotics was significantly decreased and that of atypical antipsychotics was increased. Especially, the use of quetiapine showed great increase. In bipolar depression, the use of antidepressant was increased.
ConclusionzzThis study showed significant changes have occurred in the prescription patterns in patients with bipolar disorder in the last four years. These results seem to reflect the accumulating evidence-based data for the treatment of bipolar disorder, and will provide the useful information to clinicians in practical situations.

국문 초록 (Abstract)

본 연구에서는 1998~2001년, 그리고 2009~2012년에 양극성장애 진단하에 입원 치료를 받은 환자군에서 약물 사용의 경향을 일 대학병원을 대상으로 검토하였고 각 4년간의 약물 치료 경향 및 10여 년간의 변화 동향을 조사 분석하여 실제 임상에서 활용할 수 있도록 도움을 주고자 하였다. 조사 결과, 우선 삽화의 구성에 있어 10년 이전에 비해 최근 4년간 조증 삽화에 비해 혼재성 및 우울삽화의 비율이 증가하였다. 기분조절제로는 lithium의 사용이 감소하였고 valproate의 사용이 증가하였다. 우울삽화에서는 lamotrigine의 두드러진 사용 증가가 나타났다. 기분조절제와 전체 항정신병약물의 병합은 비슷한 수준으로 높은 비율을 보였으나 항정신병약물 중 비정형 항정신병약물 처방은 증가하고 정형 항정신병약물 처방은 큰 폭으로 감소하였다. 비정형 항정신병약물 중에 risperidone의 사용은 큰 폭으로 감소하고, quetiapine과 ar-ipiprazole의 사용이 크게 증가하였다. 항우울제의 경우, 1998~ 2001년에 비해 2009~2012년에는 양극성 우울증에서 항우울제의 사용이 유의하게 증가하였다. 이러한 변화들은 치료진과 환자, 그리고 환자 보호자들의 빠른 치료에 대한 기대, 신속한 치료 효과 및 약물의 안전성과 내약성에 대한 축적된 연구 결과들을 반영한 결과라 생각할 수 있다. 본 연구 결과는 처음 연구 목적과도 같이 임상 현장에서 치료 계획을 세울 때 실질적인 도움이 될 수 있을 것이다.

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