社團法人臺灣臨床藥學會

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【原著】利用臺灣健保資料庫分析精神分裂症門診病人初次自殺傷害 行為與其服用藥品的關聯性
The Relationship between Medication and the First Suicidal Behavior in Schizophrenia Outpatients in Taiwan: A Population-Based Study
初次自殺傷害行為、精神分裂症、抗精神病類藥品、The First Suicidal Behavior, Schizophrenia, Antipsychotics
趙汝殷Ju-Yin Chao1.2 、溫燕霞Yen-Hsia Wen1 、唐滋憶Tz-Yi Tang1.3 、張堯舜Yau-Shunne Chang2 、吳信昇Hsin-Sheng Wu*1
1高雄醫學大學藥學院藥學系 、2靜和醫院燕巢分院藥劑科 、3戴德森醫療財團法人嘉義基督教醫院藥劑科
目的: 以全民健康保險研究資料庫分析精神分裂症病人服用藥品與初次自殺傷害行為的相關性。
方法: 本研究為回溯性的資料分析,資料來源為 2006 至 2010 年全民健保醫療院所門診申報資料,篩選出有精神分裂症病人的研究樣本共 5,515 人。再從研究樣本中找出有初次自殺傷害行為前最近一次有門診就診紀錄的病人稱自殺組共 35 人。接著再從研究樣本找出與自殺組有相同分層條件者稱為分層的抽樣組,人數為 1,122 人。自殺組與分層的抽樣組經電腦以 1:1 進行分層隨機抽樣篩選出分層的抽出組,用自殺組和分層的抽出組進行兩組間藥品統計分析,並重複前述動作 50 次,以有統計意義的藥品為其與自殺傷害行
為具有相關性,進而推論這些藥品可能有增加或降低病人自殺傷害行為的情形。
結果: 降低自殺可能性的藥品有haloperidol(5 次)、risperidone(5 次)、sulpiride(4 次)。增加自殺可能性的藥品有flunitrazepam(7 次)、clonazepam(3 次)、estazolam(2 次)、flupentixol(1 次)。
結論: 精神分裂症是一種需要長期藥物治療與醫療復健的慢性精神疾病。本研究目的在於臨床上建議醫師,抗精神病藥品朝使用有正面影響的藥品(如:haloperidol、risperidone、sulpiride),避免使用會有負面影響的藥品(如:flupentixol)。同時也建議醫療人員在使用輔助性藥品治療時,需特別注意鎮靜安眠類的藥品 flunitrazepam, estazolam 和抗癲癇類的藥品clonazepam,因為這一些藥品對自殺傷害行為是有負面影響。
 
Objectives: This is a retrospective, population-based study on the relationship between medication and the first suicidal behavior in schizophrenia outpatients in Taiwan.
Methods: The insurance outpatient claims data obtained from the National Health Insurance in Taiwan from 2006 to 2010. A total of 5,515 patients with diagnosis of schizophrenia were qualified.Suicide group had 35 patients with psychiatric treatment outpatient record before initial suicidal behavior occurred. Stratified samples group had 1,122 stratified samples which were selected based on the same conditions in the corresponding suicide group. The medication analysis by computer at 1:1 stratified random sampling between 2 groups to filter out 50 sets. We made an inference of some drugs which may increase or decrease incidence of suicidal behaviors by the statistically analyzed results.
Results: The drugs that may decrease the incidence of suicidal behaviors were haloperidol (5 times statistically significant), risperidone (5), sulpiride (4). The drugs that may increase the suicidal incidence were flunitrazepam (7), clonazepam (3), estazolam (2), and flupentixol (1).
Conclusions: Schizophrenia is a chronic mental illness which need long-term medication treatment and medical rehabilitation. This study suggests clinicians may choose positive effects of antipsychotics haloperidol, risperidone and sulpiride instead of negative impact antipsychotic flupentixol. Also recommended that when the medical staff in the use of complementary medicines treatment, they need to pay special attention to the negative impact of the sedative hypnotic drugs f lunitrazepam, estazolam and antiepileptic drug clonazepam on suicidal behaviors.
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