ผลการใช้ยาต้านโรคจิตตามแนวปฏิบัติในการดูแลรักษาผู้ป่วยโรคสมองเสื่อม

บทคัดย่อ

Objective The purposes of this study were to evaluate the antipsychotic prescriptions of patients with dementia in Srithanya Hospital.

Materials and methods This retrospective study was performed in dementia patients admitted to Srithanya hospital. Medical records were reviewed  from October 2013 - September 2014 by two psychiatrists. Demographic data, antipsychotic prescriptions, extrapyramidal symptoms, incidence of neuroleptic malignant syndrome were collected. And assessed the practice after the implementation of Srithanya hospital’s clinical practice guideline for dementia. Descriptive statistics was determined by odds ratio.

Results There were 57 dementia patients and 144 antipsychotic prescriptions were analyzed. All prescribing was clinically indicated. Off these, 60% was a single oral antipsychotic which risperidone was the most frequently prescribed (51%). The antipsychotic prescriptions not follow the clinical practice guideline caused three times side effects higher than those of the prescriptions follow the guideline. Among the prescriptions not follow the guideline, there were overdose oral antipsychotics (19%), inappropriate oral antipsychotics (2%), haloperidol for parkinson’s disease dementia (1%), long acting antipsychotics (3%), antipsychotic injections for acute agitation (14%). Drug induced parkinsonism was reported at 35% and neuroleptic malignant syndrome at 3%.

Conclusion The antipsychotic prescriptions not follow the clinical practice guideline caused three times side effects higher than those of the prescriptions follow the guideline, therefore the practical guideline for antipsychotic prescription in dementia patients should be developed.