抗精神病药物使用的明智选择

mal

1.在未进行合理的初始评估和持续监测的情况下，不要为患者处方抗精神病药物；

2.不要同时常规处方2种或2种以上抗精神病药物；

3.在治疗老年痴呆症患者的行为和心理症状时，不要首选抗精神病药物；

4.不要常规用抗精神病药物一线治疗成年人的失眠症状；

5.不要常规处方抗精神病药物一线治疗青少年儿童精神障碍以外的任何疾病。

Prescilla

抗精神病药只是精神类药物中的一大类，也就是咱们俗称的“精分药”，主要用于对抗幻觉妄想等精神状态；有时也或长或短的被医生用作别的用途，比如治疗失眠或情感稳定，取决于他的学术观点和用药习惯。
此论坛病人常用的精神类药物包括抗抑郁药物，安定类药物，和心境稳定剂等，则并不属于抗精神病药物的范畴

小丁

这文章越转越糊涂～

mal

美国精神病学会列出可能不必要的抗精神病药物用法:

http://blog.sina.com.cn/s/blog_5dbbb36d0101gb01.html
http://www.choosingwisely.org/do ... iatric-association/

mal

Prescilla 发表于 14-6-24 15:32
抗精神病药只是精神类药物中的一大类，也就是咱们俗称的“精分药”，主要用于对抗幻觉妄想等精神状态；有时 ...

yes, you are right.

Antipsychotic medications are used to treat schizophrenia and schizophrenia-related disorders.
Depression is commonly treated with antidepressant medications.
Bipolar disorder is commonly treated with mood stabilizers. Sometimes, antipsychotics and antidepressants are used along with a mood stabilizer.

mal

小丁 发表于 14-6-24 15:54
这文章越转越糊涂～

1
Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.

Metabolic, neuromuscular and cardiovascular side effects are common in patients receiving antipsychotic medications for any indication, so thorough initial evaluation to ensure that their use is clinically warranted, and ongoing monitoring to ensure that side effects are identified, are essential. “Appropriate initial evaluation” includes the following: (a) thorough assessment of possible underlying causes of target symptoms including general medical, psychiatric, environmental or psychosocial problems; (b) consideration of general medical conditions; and (c) assessment of family history of general medical conditions, especially of metabolic and cardiovascular disorders. “Appropriate ongoing monitoring” includes re-evaluation and documentation of dose, efficacy and adverse effects; and targeted assessment, including assessment of movement disorder or neurological symptoms; weight, waist circumference and/or BMI; blood pressure; heart rate; blood glucose level; and lipid profile at periodic intervals.

2
Don’t routinely prescribe two or more antipsychotic medications concurrently.

Research shows that use of two or more antipsychotic medications occurs in 4 to 35% of outpatients and 30 to 50% of inpatients. However, evidence for the efficacy and safety of using multiple antipsychotic medications is limited, and risk for drug interactions, noncompliance and medication errors is increased. Generally, the use of two or more antipsychotic medications concurrently should be avoided except in cases of three failed trials of monotherapy, which included one failed trial of Clozapine where possible, or where a second antipsychotic medication is added with a plan to cross-taper to monotherapy.

3
Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.

Behavioral and psychological symptoms of dementia are defined as the non-cognitive symptoms and behaviors, including agitation or aggression, anxiety, irritability, depression, apathy and psychosis. Evidence shows that risks (e.g., cerebrovascular effects, mortality, parkinsonism or extrapyramidal signs, sedation, confusion and other cognitive disturbances, and increased body weight) tend to outweigh the potential benefits of antipsychotic medications in this population. Clinicians should limit the use of antipsychotic medications to cases where non-pharmacologic measures have failed and the patients’ symptoms may create a threat to themselves or others. This item is also included in the American Geriatric Society’s list of recommendations for “Choosing Wisely.”

4
Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.

There is inadequate evidence for the efficacy of antipsychotic medications to treat insomnia (primary or due to another psychiatric or medical condition), with the few studies that do exist showing mixed results.

5
Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.

Recent research indicates that use of antipsychotic medication in children has nearly tripled in the past 10 to 15 years, and this increase appears to be disproportionate among children with low family income, minority children and children with externalizing behavior disorders (i.e., rather than schizophrenia, other psychotic disorders and severe tic disorders). Evidence for the efficacy and tolerability of antipsychotic medications in children and adolescents is inadequate and there are notable concerns about weight gain, metabolic side effects and a potentially greater tendency for cardiovascular changes in children than in adults. Additional information on medication use in children and adolescents.

mal

Use of an Antipsychotic Medication in Children and Adolescents for the Treatment of Bipolar Disorder
or the Treatment of Irritability Associated With Autism

The Choosing Wisely® campaign is an initiative of the ABIM Foundation. For this campaign, the American Psychiatric Association has identified five uses of antipsychotic medications that physicians and patients should question, including “routine” prescription of an antipsychotic medication “as a first-line intervention for children and adolescents for any diagnosis other
than psychotic disorders.”
In this document, APA clarifies that an antipsychotic medication may be an appropriate first- line option for the treatment of bipolar disorder in children and adolescents or for the treatment of irritability associated with autism spectrum disorder in children and adolescents. Such uses are supported by clinical opinion as well as guidelines based on evidence from randomized, controlled trials, e.g., practice parameters by the American Academy of Child and Adolescent Psychiatry for the treatment of bipolar disorder (2007) and autism (in press). Furthermore, risperidone, aripiprazole, quetiapine, and olanzapine have specific approval from the Food and Drug Administration (FDA) for the treatment of mania in children and adolescents, and aripiprazole and risperidone are both FDA approved for the treatment of irritability (aggression, self-injury, severe tantrums) associated with autism in children and adolescents.
Through the Choosing Wisely campaign, APA invites physicians and patients to question the routine use of antipsychotics in specific populations of patients and for specific clinical circumstances, with the aim of reducing unnecessary prescribing of these medications. As described in APA’s Choosing Wisely statement, prescription of antipsychotic medications in children “has nearly tripled in the past 10 to 15 years, and this increase appears to be disproportionate among children with low family income, minority children and children with externalizing behavior disorders (i.e., rather than schizophrenia, other psychotic disorders and severe tic disorders).” Antipsychotics may be unnecessary, for example, when they are prescribed without a comprehensive assessment or accurate diagnosis, for behavior problems such as frequent temper tantrums, or before trying interventions with low potential for adverse
effects, such as family-based, behavioral and environmental interventions. In contrast to these psychosocial interventions, antipsychotic medications in children and adolescents are associated with serious potential harms, including weight gain, metabolic side effects and cardiovascular change.
For any indication and for any patient, the potential harms of treatment must be weighed against the potential benefits. For the Choosing Wisely campaign, APA advises physicians and patients to question the routine use of antipsychotic medications in children and adolescents for clinical circumstances that are not endorsed by available clinical practice guidelines or for indications that do not have FDA approval. This advice is not inconsistent with the fact that for some young patients, an antipsychotic medication may an appropriate choice of treatment if the clinical benefits are judged to outweigh potential harms and if the patient receives appropriate initial evaluation and ongoing monitoring.