精神疾患を持つ患者における向精神薬の内服種類数・総量と摂食・嚥下障害の帰結との関係―高齢者を主な対象とした事後的検証

The Relation between the Number, Kind and Total Amount of Psychoactive Drugs Used and the Outcome of Dysphagia in Patients with Psychiatric Disorders

要旨　目的：精神疾患を持つ患者の摂食・嚥下障害の帰結と向精神薬の関係を検証する．方法：2011年1月～2012年4月に当院精神科入院中，摂食・嚥下障害に言語聴覚療法を処方した患者53人を後方視的に，退院時の経口のみでの栄養摂取の可否で不良群と良好群に分類し，入退院時の定型・非定型抗精神病薬，睡眠薬・抗不安薬，抗うつ薬，気分安定剤の内服種類数，定型・非定型抗精神病薬の総量，年齢，性別，精神科基礎疾患とその罹病期間，中枢神経疾患の既往，誤嚥性肺炎の合併，入院・介入期間，入院時GAF尺度を統計学的に考察した．結果：摂食・嚥下障害の帰結に，入院時の抗精神病薬，特に定型抗精神病薬の内服種類数が有意に関連した．抗精神病薬，特に非定型抗精神病薬の内服総量は良好群で多かった．結論：摂食・嚥下障害発症前から抗精神病薬，特に定型抗精神病薬の多剤併用を避け，非定型抗精神病薬を単剤で投与することが，実用的な経口摂取につながりうる．

Abstract　Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.