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

다국어 초록 (Multilingual Abstract)

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.

국문 초록 (Abstract)

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.

참고문헌 (Reference)

1 조현상, "한국형 정신분열병 약물치료 알고리듬의 임상 적용 가능성(IV)：과거 항정신병약물 치료력이 약물 효과 및 알고리듬 적용에 미치는 영향" 대한정신약물학회 17 (17): 162-173, 2006

2 이황빈, "한국형 우울장애 약물치료 알고리듬 2012(II) : 정신병적 양상을 동반한 우울장애" 대한우울∙조울병학회 11 (11): 12-19, 2013

3 송후림, "한국형 우울장애 약물치료 알고리듬 2012(I) : 정신병적 양상이 없는 주요우울장애" 대한우울∙조울병학회 11 (11): 5-11, 2013

4 윤보현, "한국형 양극성 장애 약물치료 알고리듬 2010: 다른 치료 지침들과의 비교" 대한정신약물학회 22 (22): 171-182, 2011

5 이정구, "한국형 양극성 장애 약물치료 알고리듬 2010 : 유지치료" 대한우울∙조울병학회 9 (9): 162-170, 2011

6 우영섭, "정신과적 질환에 대한 새로운 약물요법" 대한의사협회 54 (54): 1061-1069, 2011

7 Hermes ED, "Use of second-generation antipsychotic agents for sleep and sedation: a provider survey" 36 : 597-600, 2013

8 Kamble P, "Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data" 26 : 483-492, 2009

9 Meltzer HY, "Update on typical and atypical antipsychotic drugs" 64 : 393-406, 2013

10 American Psychiatric Association, "Treatment of patients with major depression and practical guideline"

11 Judd LL, "The long-term natural history of the weekly symptomatic status of bipolar I disorder" 59 : 530-537, 2002

12 Park JI, "The advantage of using 3-week data to predict response to aripiprazole at week 6 in first-episode psychosis"

13 Grunze H, "The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2010 on the long-term treatment of bipolar disorder" 14 : 154-219, 2013

14 Grunze D, "The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania" 10 : 85-116, 2009

15 Pacchiarotti I, "The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders" 170 : 1249-1262, 2013

16 Maher AR, "Summary of the comparative effectiveness review on off-label use of atypical antipsychotics" 18 (18): S1-S20, 2012

17 Bulloch AG, "Substantial changes in prescription recommendations for bipolar disorder in Canada: 2002-2010" 57 : 263-268, 2012

18 Han C, "Second-generation antipsychotics in the treatment of major depressive disorder: current evidence" 13 : 851-870, 2013

19 Chen YC, "Quetiapine fumarate augmentation for patients with a primary anxiety disorder or a mood disorder: a pilot study" 12 : 162-, 2012

20 Calvó-Perxas L, "Profile and variables related to antipsychotic consumption according to dementia subtypes" 24 : 940-947, 2012

21 Bret P, "Prescribing patterns of antipsychotics in 13 French psychiatric hospitals" 35 : 129-138, 2009

22 National Institute for Health and Clinicall Excellence, "NICE implementation uptake report: Bipolar disorder" National Institute for Health and Clinicall Excellence 1-10, 2009

23 Goodwin GM, "Evidence-based guidelines for treating bipolar disorder: revised second edition--recommendations from the British Association for Psychopharmacology" 23 : 346-388, 2009

24 Luca M, "Epidemiology and treatment of mood disorders in a day hospital setting from 1996 to 2007: an Italian study" 9 : 169-176, 2013

25 Yatham LN, "Efficacy of aripiprazole versus placebo as adjuncts to lithium or valproate in relapse prevention of manic or mixed episodes in bipolar I patients stratified by index manic or mixed episode" 147 : 365-372, 2013

26 Park SW, "Effects of antipsychotic drugs on the expression of synaptic proteins and dendritic outgrowth in hippocampal neuronal cultures" 67 : 224-234, 2013

27 Voicu V, "Drug-induced hypo- and hyperprolactinemia: mechanisms, clinical and therapeutic consequences" 9 : 955-968, 2013

28 Jing Y, "Dosing patterns of aripiprazole and quetiapine for adjunctive treatment of major depressive disorder (2006-2010)" 28 : 87-90, 2013

29 Citrome L, "Dose trends for second-generation antipsychotic treatment of schizophrenia and bipolar disorder" 108 : 238-344, 2009

30 Leggio GM, "Dopamine D3 receptor as a new pharmacological target for the treatment of depression" 719 : 25-33, 2013

31 Centorrino F, "Changes in medication practices for hospitalized psychiatric patients: 2009 versus 2004" 25 : 179-186, 2010

32 Kennedy SH, "Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. Introduction" 117 (117): S1-S2, 2009

33 Yatham LN, "Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009" 11 : 225-255, 2009

34 Thase ME, "Bipolar disorder maintenance treatment: monitoring effectiveness and safety" 73 : e15-, 2012

35 Jon DI, "Augmentation of aripiprazole for depressed patients with an inadequate response to antidepressant treatment: a 6-week prospective, open-label, multicenter study" 36 : 157-161, 2013

36 Chen TY, "Aripiprazole: a dopamine modulator that mimics methylphenidate in producing faster antidepressant effects" 81 : 183-185, 2013

37 Chen BH, "Aripiprazole, an atypical antipsychotic drug, improves maturation and complexity of neuroblast dendrites in the mouse dentate gyrus via increasing superoxide dismutases" 38 : 1980-1988, 2013

38 Atik L, "Antipsychotic prescriptions in a university hospital outpatient population in Turkey: a retrospective database analysis, 2005-2006" 32 : 968-974, 2008

39 Roh D, "Antipsychotic polypharmacy and high-dose prescription in schizophrenia: a 5-year comparison"

40 Decoutere L, "Antipsychotic agents in the treatment of somatoform disorders; a review" 53 : 163-173, 2011

41 Wang LJ, "Adjunctive effects of aripiprazole on metabolic profiles: comparison of patients treated with olanzapine to patients treated with other atypical antipsychotic drugs" 40 : 260-266, 2013

42 Ketter TA, "Adjunctive aripiprazole in treatment-resistant bipolar depression" 18 : 169-172, 2006