정신건강의학과 입원 환자의 Aripiprazole 사용 변화: 일 대학병원에서 2004~2008년과 2009~2013년의 비교 (Changes in Aripiprazole Usage in the Psychiatric Inpatients at a University Hospital between 2004-2008 and 2009-2013)

서지정보

· 발행기관 : 대한정신약물학회
· 수록지 정보 : 대한정신약물학회지 / 25권 / 1호 / 21 ~ 28페이지
· 저자명 : 심인희, 우영섭, 전태연, 박원명

초록

본 연구의 결과를 통하여 최근 aripiprazole의 처방에 있어양극성장애의 치료 및 주요우울장애에서 부가요법 등 기분장애에서의 사용이 증가하였음을 알 수 있었다. 이는 aripiprazole이체중증가, 당 내성 및 대사증후군, 고프로락틴혈증, 그리고 졸림 등 부작용에 대하여 뛰어난 내약성을 가지는 것과관련이 있을 것이다. 또한 약물 작용기전과 관련하여 신경영양성인자 증가에 따른 신경가소성 활성화 및 D3 작용으로 인한 항우울제 작용, 그리고 D2 부분 효현 작용으로 인한 methylphenidate와같은 각성 효과 등 치료효과도 기여하였을것이다. 그리고 이러한 근거를 바탕으로 국내외의 대표적인기분장애 약물치료 알고리듬 및 지침서에서 aripiprazole 등비정형 항정신병약물이 주요한 치료전략으로 약진하는 등 최근의 학문적 발전 경향이 영향을 미쳤을 것으로 생각된다.

영어초록

ObjectivezzPatterns of clinical use of aripiprazole have changed greatly in the past decade. We aimed to assess changes inthese patterns in an inpatient unit at a university hospital between 2004–2008 and 2009–2013.
MethodszzThe subjects (n=182) were inpatients treated with aripiprazole between September 2004 and May 2013 whowere categorized according to time period: Sep 2004–Dec 2008 (n=42) or Jan 2009–May 2013 (n=142). Aripiprazole wasapproved as an adjunctive therapy for patients with major depressive disorder by the Korea Food and Drug Administration in2008. The subjects’ charts were retrospectively reviewed to ascertain the distribution of psychiatric diagnoses and to identifyother factors related to diagnosis, such as demographic characteristics, starting/maximum doses, and treatment regimen.
ResultszzComparison of the two time periods showed that the most common psychiatric diagnoses changed from schizophreniaand other psychotic disorders to mood disorders such as major depressive disorder and bipolar disorder. Aripiprazolewas more often prescribed for bipolar disorder, depressed patients during 2009–2013 than during 2004–2008 (15.5% vs. 2.4%,p=0.047). Patients with schizophrenia and other psychotic disorders (p=0.005), major depressive disorder (p=0.006), bipolardisorder, manic/mixed (p=0.006) and other diagnoses (p=0.029) had significantly lower starting doses during 2009-2013than during 2004–2008. Although a trend was found toward a higher aripiprazole dose for schizophrenia and other psychoticdisorders during 2009–2013 than during 2004-2008, the difference was not significant (28.3±1.4 vs. 22.1±2.1, p=0.061).
ConclusionzzTreatment with aripiprazole has been extended beyond schizophrenia and other psychotic disorders to mooddisorders and other diagnoses in clinical practice. The majority of patients treated with aripiprazole during the later periodreceived lower starting doses than did those during the earlier one, although maximum doses varied depending on the psychiatricdiagnosis.

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