| BackgroundBipolar disorder is a kind of mood disorder with manic/hypomanic episode and depressive episode.Bipolar disorder has been widely valued by scholars at home and abroad for its large number of depressive episodes,long duration,large social damage and high suicide rate.Its treatment is still difficult in psychiatry,and drug treatment is widely used at present.The survey found that although the rationality of medication in the treatment of bipolar depression has increased,irrational medication still exists.As a newly established municipal mental health institution,our hospital should pay more attention to the rationality of drug use.ObjectivesObjective to investigate and analyze the current situation of drug use and treatment options of bipolar depression patients in Anyang mental hospital.The treatment regimens were grouped according to the different grades of guideline recommended recommendations,and the consistency of the treatment regimens with the guidelines was judged and justified.To provide improved advice and evidence for the pharmacological treatment of patients with depressive episodes of bipolar disorder,further improve the clinical cure rate,and make the treatment of patients safer and effective.Methods118 patients with bipolar depression who met the ICD-10 diagnostic criteria fromOctober 2016 to October 2019 were selected as the subjects of this study.By reviewing the medical records,using a self-made questionnaire to record the basic information of each patient,the treatment plan and the selection of drugs at the time of admission(day 3)and discharge,and the treatment effect.The treatment plan and the use of various psychotropic drugs were summarized,and the spss19.0 software was used for statistical analysis.Combined with the recommendations of the drug regimens in the"Chinese guidelines for the prevention and treatment of bipolar disorder"(Second Edition),different hierarchical groupings of the ABCD were performed to evaluate the consistency of the guidelines and the rationalization of the treatment regimens for patients with depressive episode of bipolar disorder in Anyang mental health hospital,and the unreasonable medication situation was discussed and suggestions for improvement were made.Results1.Among 118 patients with bipolar depression,54 were male and 64 were female,most of them were young and middle-aged.2.There were 64 cases(54.24%)and 70 cases(59.32%)based on mood stabilizers at admission and discharge,and the difference was not statistically significant(χ~2=0.622,P=0.430).Valproate was used the most during admission and discharge,with 44 cases(37.29%)and 41 cases(34.75%)respectively.There were 64 cases(54.24%)and 82 cases(69.49%)based on antipsychotics at the time of admission and discharge,the difference was statistically significant(χ~2=5.819,P=0.016).The number of patients who used quetiapine increased from 24(20.34%)at admission to 39(33.05%)at discharge,and the difference was statistically significant((χ~2=5.056,P=0.025).There were 95 cases(80.51%)and 97 cases(82.20%)with antidepressant-based treatment plans on admission and discharge,and the difference was not statistically significant(χ~2=0.112,P=0.738),Escitalopram was used the most during admission and discharge,with 40 cases(33.90%)and 39 cases(33.05%)respectively.The use rate of sedative hypnotics at discharge was significantly lower than that at admission,while the use rate of lipid-lowering drugs,hypoglycemic drugs,heart rate lowering drugs,whitening drugs and anticholinergic drugs increased significantly,and the differences were statistically significant(P<0.05).3.There were 34 patients(28.81%)and 21 patients(17.80%)treated with single drugs at admission and discharge respectively,and the difference was statistically significant(χ~2=4.006,P=0.045).Among the patients taking antidepressants alone,2 cases turned into a manic state.The number of patients treated with the antidepressant escitalopram was reduced from 31(26.27%)to 10(8.47%),the difference was statistically significant(χ~2=13.018,P<0.001).The number of patients treated with the quetiapine was increased from 0 case(0.00%)to 6 cases(5.08%),the difference was statistically significant(χ~2=6.157,P=0.013).There were 63 patients(53.39%)and 72 patients(61.02%)treated with two-drug combination therapy at admission and discharge respectively,and the difference was not statistically significant(χ~2=1.402,P=0.236).The number of patients treated with the combination of antidepressants and antipsychotics increased from 22(18.64%)to 37(31.36%),and the difference was statistically significant(χ~2=5.085,P=0.024).There were 21(17.80%)patients and 25(21.19%)patients treated with the three-drug combination therapy at admission and discharge,and the difference was not statistically significant(χ~2=0.432,P=0.511).4.Compared with the guideline treatment recommendations,the number of patients with unreasonable medications decreased from 73(61.86%)at admission to 54(45.76%)at discharge.the number of patients with reasonable medication increased from 45(38.14%)at the time of admission to 64(54.24%)at the time of discharge.The difference was statistically significant(χ~2=6.154,P=0.013).There was no significant difference in the choice of B and D recommended treatment options at admission and discharge(χ~2=0.434/0.733,P=0.510/0.392).Compared with the time of admission,A and C recommended treatment options increased significantly,and the difference was statistically significant(χ~2=7.214/4.281,P=0.007/0.039).The number of treatments not recommended by the guidelines was significantly reduced,and the difference was statistically significant(χ~2=8.213,P=0.004)。5.According to the discharge effect provided by the HIS system,the effective rate of bipolar disorder-depressive episode patients after drug treatment reached 88.98%,the effective rates of single-drug therapy,two-drug combination and three-drug combination were 52.38%,95.83%and 96.00%,respectively,combination medication is significantly better than monotherapy.There was significant difference between the effective rate of single agent treatment and the effective rate of all patients(χ~2=15.832,P=0.001).The effective rate of the combination of two drugs and the combination of three drugs was not statistically significant compared with the overall effective rate(χ~2=3.477,χ~2=2.767,both P>0.05).There was a statistically significant difference in the treatment effect between the three treatment methods(χ~2=27.983,P<0.05).ConclusionsQuetiapine,valproate and escitalopram were the most used drugs for the treatment of depressive episode of bipolar disorder in our hospital,and antipsychotics combined with antidepressants were the main treatment regimens.Comparing the guidelines,the use rate of A-level and B-level recommended programs is relatively small,while the frequency of use of antidepressants is too high,and the selection of some antidepressants is unreasonable,which may lead to the risk of phase transition.Through the treatment in our hospital,the rationality of the patient’s treatment plan has been improved,but there are still differences with the guidelines,and further training is needed. |
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