中文摘要
　　精神分裂症最主要治療的方式為藥物治療。因目前為止，藥物處方開立，並無統一性準則參考，且隨著新抗精神病藥物的研發上市，增加醫師處方的選擇性，加以其它多種因素的影響，改變醫師處方型態。所以本研究想瞭解精神科專科醫師對精神分裂症症患者之抗精神病藥物之處方型態。

　　精神分裂症患者需長期使用抗精神病藥物來預防復發。但研究統計社區精神分裂症病患未按醫囑服用藥者約有50%，甚至更多。本研究想瞭解影響病患服藥順服性的因素，以便進一步改善病患服藥順服性。

　　本研究分成三部分，第一部分為抗精神病藥物的使用評估，分析成大醫院門診精神分裂症病患使用抗精神病藥物之處方型態，包括：抗精神病藥物的處方比例、使用劑量、抗精神病藥物多重用藥及合併其它精神藥物的使用情況。第二部分就成大資訊室提供病患就醫資料庫，分析門診精神分裂症患者之就醫型態及可能之藥物順服性。並比較長期追踪患者及新個案就醫型態之異同。第三部分以問卷訪談方式，評估長期於門診追踪之精神分裂患者之藥物的態度、知識及順服性。

　　2003年成大醫院精神分裂症病患治療處方模式，在786名病患中，有78%為單一抗精神病藥物的治療，以第一代抗精神病藥物(39.8%)為主，第二代抗精神病藥物的處方是增加的。在藥物劑量方面，大部分抗精神病藥物的處方劑量偏低於國外準則建議治療劑量範圍，有少部分的藥品甚至低於建議的治療劑量。在抗精神病藥物的多重用藥方面，抗精神病藥物合併使用比例，2003年22.1%合併使用抗精神病藥物較2001年的併用比例增加。併用時間超過2個月的人數約有14.5%，每位病患平均併用天數約6個月。二個第一代抗精神病藥物併用由2001年87%降低至2003年52%，取而代之的併用型態為第一代合併第二代抗精神病藥物。在併用其它精神藥物方面，高逹83.6%曾併用其它精神藥品，平均每位病患併用2.1種精神藥品。抗巴金森氏症藥物處方比例及使用劑量在單一長效針劑組及多重用藥的分組中為最高。曾經被處方benzodiazepine類藥品(包括失眠藥品及抗焦慮藥品)、情緒穩定劑及抗憂鬱藥品的人數比例分別為81%(52.8%+28.2%)、12.7%及11.7%。多重抗精神病藥物治療組於併用安眠藥品、抗焦慮藥品及抗巴金森氏症藥物的使用劑量高於單一抗精神病藥物治療組。

　　病患服藥順性方面，2002至2003年精神分裂症病患成大醫院資料庫觀察發現，2002年在成大醫院精神科門診且2003年持續門診追踪的舊病患較2002年未曾在成大醫院精神科門診就診但2003年在門診追踪的新病患之回診天數(大於282天以上)及服用藥物持續性大於80%的人數比例高(33% vs 11%, p<0.05)。問卷訪視結果發現，病患對使用抗精神病藥物是持負面態度及明顯不足的使用藥物知識。

　　評估精神分裂症治療發現有高比例會合併使用抗精神病藥物及其它精神藥物，所造成的藥物交互作用的安全性考量是值得重視。另外，本研究抗精神病藥物的使用劑量相較於國外使用劑量建議準則有偏現象，是否會影響療效？需要進一步研究。教育患者正確用藥態及知識，可幫助我們提供精神分裂症病患更有效、更安全的醫療照顧。

Abstract
　Background: Pharmacotherapy is an important management for patients with schizophrenia. Up to date, the prescribing pattern was affected by many factors which includes drug of choice, inconsistency of treatment guideline, patient’s condition, and physicians’ behavior etcetera. Schizophrenia is a kind of chronic illness that needs long-term antipsychotic treatment to control patients’ condition without getting worse and to prevent the risk of relapse. Statistical data have revealed that more than 50% outpatients behaved poor medication compliance and increased the risk of relapse. Hence, we aim to study the cause of poor medication compliance of patients with schizophrenia, and to seek therapeutic alliance strategies of improvement.

　Method: The prescribing patterns were investigated retrospectively by using the outpatient database of Psychiatry Department in the National Cheng-Kung University Hospital (NCKUH) from January 2003 to December 2003. For assessing patient compliance, we analysed whether there are differences between the long term outpatients and new outpatients regarding the duration of follow-up. Besides, we conducted the questionnaires and interview to evaluate medication compliance, attitude and knowledge in the long-term follow-up patients with schizophrenia.

　Results: Data of 786 patients with schizophrenia were used in this study. 78 percent of the patients received only one kind of antipsychotic, within which 313 patients (39.8%) were prescribed with the first generation antipsychotics (FGAs). The data also presented that the doses of most of antipsychotics were prescribed in the lower recommended range.

　Combination use of antipsychotics is increasing gradually. According to the study, in 2003, the use of combination antipsychotics was 22.1% and the mean of duration of combination use was 4.5months. The use of antipsychotic polypharmacy for more than 2 months were 14.5%, and the mean combination duration were about 6 months. In 2001, the rate of combination use of two FGAs was 87%, and was reduced to 52% in 2003. However, the combination of FGAs plus second generation antipsychotic (SGAs) was increased.

　In multiple psychotropic pharmacotherapy, 83.6% patients were prescribed with other psychotropic agents, and the mean of items in psychotropic agents was 2.1. The frequency of prescribing antiparkinson drug is highest in the depot antipsychotic group and polypharmacy group. Patients were prescribed 81% benzodiazepine, 12.7% mood stabilizer, and 11.7% antidepressants repectively. More doses of hypnotic, anxiolytic drug, and antiparkinson drug were prescribed in antipsychotic polypharmacy group than antipsychotic alone group.

　In the aspect of drug compliance, the statistical data have shown that the long-term follow-up outpatients have higher rate (＞80%)than others. From the analysis of questionnaire data, in all, not only the patients in the oral group but also the injectable group presented negative attitude of medication and inadequate knowledge toward the usage of medication. .

　Conclusion: Nowadays, the trend of polypharmacy in combining antipsychotic and psychotropic agents was demonstrated high percentage in schizophrenia therapy. Consequently, more attentions should be dreqwn toward safety concerns due to potential drug-drug interaction. Furthermore, the education of accurate medication attitude and knowledge could help the patients receive more effective and safer medical care.

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