일 대학병원 양극성장애 외래 환자에서 약물 처방 경향: 비정형 항정신병약물을 중심으로 = A Trend of Medication Prescription Pattern for Outpatients with Bipolar Disorder in a University Hospital: Focusing on Atypical Antipsychotics

다국어 초록 (Multilingual Abstract)

ObjectivezzAtypical antipsychotics and newly developed anticonvulsants have become increasingly popular medication for bipolar disorder. Especially, atypical antipsychotics have increasing importance in treatment of bipolar disorder and a number of treatment guideline recommend atypical antipsychotics for pharmacological treatment of bipolar manic and depressed episodes. This study examined the prescribing patterns for medications to treat bipolar disorder in outpatient-based psychiatric practice focusing on atypical antipsychotics.
MethodszzRetrospective chart review of patients admitted to a university hospital with a primary diagnosis of bipolar disorder in a period from January 2008 to December 2012 was conducted. We reviewed Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis and detailed clinical information at index episode. Psychotropic medications were grouped into six categories; atypical antipsychotics, typical antipsychotics, lithium, anticonvulsants, antidepressants, and minor tranquilizers. Severity, rapid cycling type, psychiatric comorbidity and disease duration were computed focusing on atypical antipsychotics.
ResultszzIn 344 patients who were prescribed major psychotropic medications, atypical antipsychotics were prescribed in 70.9% of subjects, anticonvulsants in 73.3%, lithium in 36.9%, antidepressants in 41.9%, and typical antipsychotics in 0.9% of subjects. About 12.5% of subjects were treated with the monotherapy. Atypical antipsychotics prescription was favored in subjects with manic and mixed episodes or severe episode. Prescribing trend is independent of rapid cycling type. Prescription of antidepressants were more frequent in subjects who were recently diagnosed as bipolar disorder or prescribed new medications or existed psychiatric comorbidity.
ConclusionzzThe development of bipolar disorder’s psychopharmacology has been reflected in the prescription pattern of psychotropic medications in Korea. This study suggests that atypical antipsychotics have played major role in treatment of bipolar disorder.

국문 초록 (Abstract)

최근 양극성장애의 치료에 있어 비정형 항정신병약물 및 항경련제의 사용, 그리고 2가지 이상 약물의 병합요법이 증가하는 경향을 보이고 있다. 특히 비정형 항정신병약물은 급성기 조증뿐만 아니라 유지치료기와 양극성 우울증에서도 선호도가 지속적으로 증가하고 있다. 이러한 최근의 치료 경향이 임상에서 반영되고 있는지 확인하고자 본 연구에서는 2008년부터 2012년까지의 국내 일 대학병원 정신건강의학과 외래에서 양극성장애 환자에 대한 약물 처방을 조사하였다. 그 결과 비정형 항정신병약물은 양극성 조증삽화, 우울삽화, 혼재성삽화 및 유지치료기에 모두 빈번하게 사용되었으며, 특히 조증삽화와 혼재성삽화에서 처방 빈도가 더 높았다. 대부분의 비정형 항정신병약물은 조증, 우울증, 혼재성삽화 및 유지치료기에 고르게 처방되었으며, 모든 급성기삽화에서 aripiprazole이 가장 빈번하게 처방되었는데 이는 aripiprazole이 여러 삽화에 효과가 있다는 연구 결과로 인하여 처방이 증가한 것으로 보인다. 또한 중증 증례에서는 quetiapine과 olanzapine이 선호되었다. 또한 항우울제의 사용이 증가하는 경향 또한 관찰되었다. 결론적으로 본 연구의 결과, 양극성장애 약물치료 치료지침과 새로운 연구 결과들은 실제 임상 처방에서 많은 변화를 유발하고 있는 것으로 나타났다.

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