精神分裂症药物治疗的德尔菲法调查
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摘要
目的:调查国内精神分裂症的药物治疗现状,取得国内专家对精神分裂症药物治疗的共识,为规范精神分裂症药物治疗提供参考依据。方法:通过德尔菲法(Delphi法)选择来自我国不同省市精神专科三级医院临床专家,进行两轮专家咨询,采用描述性统计分析的方法对专家基本情况、专家意见集中程度进行分析,对问卷的各个项目采用频数的描述性分析,总结出临床治疗指导意见。结果:(1)两轮调查共有48名专家参与,来自18个省市,职称全部为副高及以上,平均从业29年以上。两轮调查的积极系数为100%。(2)调查取得了6种不同情况下抗精神病药选用顺序的推荐意见。在涉及用药及换药时机、合并用药、难治性精神分裂症治疗、非药物增效治疗、药物维持治疗等5个方面共19项治疗意见中,有11项的认同率超过2/3,达到专家共识。结论:国内精神分裂症药物治疗的专家共识是6种情况下抗精神病药前3位的推荐用药、11条具体推荐意见;存在争议的问题是合用情感稳定剂时机、超说明书用药、维持治疗时间、前驱期是否用药、难治性精神分裂症治疗方案、长效针急性期是否应用、氯氮平疗效欠佳时治疗方针、难治性精神分裂症是否应用重复经颅磁刺激。
Objective: The purpose of this study was to investigate the status of schizophrenia in drug treatment,standardized treatment of schizophrenia,to provide a reference for the next process to develop standardized treatment of schizophrenia. Method: By expert consultation( Delphi method) psychiatric clinical experts from level III psychiatric hospitals of different provinces of China were selected,througth two rounds of expert consultation,the basic situation of experts,expert advice concentration and each item on the questionnaire was analyzed using descriptive analysis frequency,summarized the clinical treatment guidance. Results:(1)Forty-eight experts participated in the two consultation,from 18 provinces and cities,at least associate chief physician or associate professor,and average employed for more than 29 years. The initiative coefficient was 100%in two rounds of expert consultant.(2)The survey resulted in recommendations on the selection order of antipsychotics in 6 different situations. Of the 19 treatment opinions in 5 aspects such as drug use and changing time,combined drug use,refractory schizophrenia treatment,non-drug efficiency treatment,and drug maintenance treatment,11 had an acceptance rate of more than 2/3,reaching expert consensus. Conclusion: Expert consensus on drug therapy in schizophrenia in China is recommended for the top 3 antipsychotic drugs in the 6 situations,and 11 specific recommendations. The controversial issues are the timing of combination of emotional stabilizers,overdose medication,maintenance of treatment time,whether antipsychotics be used in the prodromal phase of schizophrenia,treatment plan for refractory schizophrenia,whether to use long-acting injection in acute phase,treatment policy for poor efficacy of clozapine,and application of repeated transcranial magnetic stimulation for refractory schizophrenia.
Objective: The purpose of this study was to investigate the status of schizophrenia in drug treatment,standardized treatment of schizophrenia,to provide a reference for the next process to develop standardized treatment of schizophrenia. Method: By expert consultation( Delphi method) psychiatric clinical experts from level III psychiatric hospitals of different provinces of China were selected,througth two rounds of expert consultation,the basic situation of experts,expert advice concentration and each item on the questionnaire was analyzed using descriptive analysis frequency,summarized the clinical treatment guidance. Results:(1)Forty-eight experts participated in the two consultation,from 18 provinces and cities,at least associate chief physician or associate professor,and average employed for more than 29 years. The initiative coefficient was 100%in two rounds of expert consultant.(2)The survey resulted in recommendations on the selection order of antipsychotics in 6 different situations. Of the 19 treatment opinions in 5 aspects such as drug use and changing time,combined drug use,refractory schizophrenia treatment,non-drug efficiency treatment,and drug maintenance treatment,11 had an acceptance rate of more than 2/3,reaching expert consensus. Conclusion: Expert consensus on drug therapy in schizophrenia in China is recommended for the top 3 antipsychotic drugs in the 6 situations,and 11 specific recommendations. The controversial issues are the timing of combination of emotional stabilizers,overdose medication,maintenance of treatment time,whether antipsychotics be used in the prodromal phase of schizophrenia,treatment plan for refractory schizophrenia,whether to use long-acting injection in acute phase,treatment policy for poor efficacy of clozapine,and application of repeated transcranial magnetic stimulation for refractory schizophrenia.
引文
[1]傅毓维,张凌.预测决策理论与方法[M].哈尔滨:哈尔滨工程大学出版社,2003:174-193.
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[3]徐坤莲.探究精神科合理用药[J].工企医刊,2012,25(2):31.
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[5]李玲,邢志强.住院精神障碍患者合理化用药分析[J].中国医疗前沿,2010,5(23):85-86.
[6]苏宗霞,韩丽霞,刘蕊.精神分裂症住院患者应用抗精神病药1日调查分析[J].中国医院用药评价与分析,2011,11(4):342-344.
[7]罗荣连,陈骞.住院患者精神药物一日使用296例调查分析[J].中国民康医学,2009,21(14):1755.
[8]张建明,程呈斌. 586例老年精神病患者用药调查分析[J].中国医院用药评价与分析,2010,10(1):18-20.
[9]司天梅,何燕玲,周茹英,等.三个地区住院精神分裂症患者药物处方方式及影响因素[J].中国心理卫生杂志,2003,17(10):705-707.
[10] Troy AM,Nancy HC,Susan ME,et al. Real-world antipsychotic treatment practices[J]. Psychiatric Clinics North America,2007,30(3):401-416.
[11]赵靖平,施慎逊.中国精神分裂症防治指南[M]. 2版,北京:中华医学电子音像出版社,2015.
[12] Chakos MH,Glick ID,Miller AL,et al. Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial[J]. Psychiatr Serv,2006,57(8):1094-1101.
[13] Leucht S,Corves C,Arbter D. Second-generation versus first-generation antipsychotic drugs for schizophrenia:a meta-analysis[J]. The Lancet,2009,373(9657):31-41.
[14]司天梅,舒良,于欣,等. 2006年我国十省市抗精神病药处方方式的现况调查[J].中华精神科杂志,2010,43(1):1-36.
[15] Osser DN,Roudsari MJ,Manschreck T. The psychopharmacology algorithm project at the Harvard South Shore Program:an update on schizophrenia[J]. Harv Rev Psychiatry,2013,21(1):18-40.
[2] Brown B. Delphi process:a methodology using for the elicitation of opinions of experts[J]. Rand Corporation,1987,9:3925.
[3]徐坤莲.探究精神科合理用药[J].工企医刊,2012,25(2):31.
[4]陈春英,邵志梅.我院精神科门诊用药的不合理性分析[J].临床合理用药,2010,10(3):71-72.
[5]李玲,邢志强.住院精神障碍患者合理化用药分析[J].中国医疗前沿,2010,5(23):85-86.
[6]苏宗霞,韩丽霞,刘蕊.精神分裂症住院患者应用抗精神病药1日调查分析[J].中国医院用药评价与分析,2011,11(4):342-344.
[7]罗荣连,陈骞.住院患者精神药物一日使用296例调查分析[J].中国民康医学,2009,21(14):1755.
[8]张建明,程呈斌. 586例老年精神病患者用药调查分析[J].中国医院用药评价与分析,2010,10(1):18-20.
[9]司天梅,何燕玲,周茹英,等.三个地区住院精神分裂症患者药物处方方式及影响因素[J].中国心理卫生杂志,2003,17(10):705-707.
[10] Troy AM,Nancy HC,Susan ME,et al. Real-world antipsychotic treatment practices[J]. Psychiatric Clinics North America,2007,30(3):401-416.
[11]赵靖平,施慎逊.中国精神分裂症防治指南[M]. 2版,北京:中华医学电子音像出版社,2015.
[12] Chakos MH,Glick ID,Miller AL,et al. Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE trial[J]. Psychiatr Serv,2006,57(8):1094-1101.
[13] Leucht S,Corves C,Arbter D. Second-generation versus first-generation antipsychotic drugs for schizophrenia:a meta-analysis[J]. The Lancet,2009,373(9657):31-41.
[14]司天梅,舒良,于欣,等. 2006年我国十省市抗精神病药处方方式的现况调查[J].中华精神科杂志,2010,43(1):1-36.
[15] Osser DN,Roudsari MJ,Manschreck T. The psychopharmacology algorithm project at the Harvard South Shore Program:an update on schizophrenia[J]. Harv Rev Psychiatry,2013,21(1):18-40.
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