研究背景：
腦中風是因腦部血管病變所引起的腦部損傷，是常見的神經系統疾病。過去研究顯示，在腦中風存活者當中，約有12%~56%的病患會出現心理及精神相關的症狀，包括：憂鬱、焦慮、認知障礙以及精神病症狀(幻覺、妄想、激動不安)等。依據美國老年學會指引，抗精神病藥物 (antipsychotics) 被認為是治療精神病症狀的第一線用藥。然而抗精神病藥物所帶來的副作用，包含metabolic symptoms和cardiovascular effects，都可能會增加使用者的死亡風險。過去甚少有研究在探討病患在中風後使用抗精神病藥物的藥物使用情況，尤其台灣的情況所知有限。因此，本研究希望藉由分析中風病患接受抗精神病藥物治療的發生率與處方型態，進而提供臨床醫師開立抗精神病藥物之處方參考。

研究方法：
使用2000-2013年全民健保資料庫之回溯型世代研究。
研究一：研究對象為2001-2012年因缺血性中風住院且年齡≥18歲之病患，中風前一年內無任何使用抗精神病藥物之患者，分析其出院後接受抗精神病藥物治療的發生率與藥物種類，再進一步將性別與年齡分層並計算接受抗精神病藥物治療之發生率變化情況。
研究二：研究對象為2000-2013年因缺血性中風住院且年齡≥18歲之病患，中風後180天內開始在門診使用抗精神病藥物之患者。分析病患開立藥物與病患危險因子(risk factors)的關聯性，並自開始用藥後往後追蹤一年，分析藥物使用療程區間及治療改變之原因。
 
結果：
研究一：經過納入、排除與分組條件後，共有380,057位缺血性中風病患進行後續追蹤接受抗精神病藥物治療之發生率。研究對象平均為68.7歲(SD=12.62)。發現接受抗精神病藥物治療之發生率為49.6/1,000人-年， quetiapine (15.9/1,000人-年)為最常使用之抗精神病藥物，其次依序為haloperidol (14.6/1,000人-年)、risperidone (6.1/1,000人-年)、chlorpromazine (3.9/1,000人-年)、sulpiride(2.6/1,000人-年)。
研究二：經過納入、排除與分組條件後，共11,972人進行後續藥物選擇與危險因子關聯性之分析、藥物療程區間之測量以及分析治療改變之原因。發現當處方醫師具備精神科或神經科專科醫師證照、病患罹患有失智症及譫妄症時，傾向選擇risperidone；病患罹患有憂鬱症時，傾向選擇quetiapine；病患罹患有心血管-代謝症候群時，傾向選擇第一代抗精神病藥物。分析藥物療程區間以quetiapine最長，且相較於其他用藥組別，其住院率較低且存活率較高。

結論：
本研究提供缺血性中風病患使用抗精神病藥物之處方型態分析。其中選擇quetiapine治療之發生率最高、使用藥物療程區間最長之藥物，然而，因risperidone在臺灣被核准使用於失智症之行為及精神症狀，故可觀察在老年或是罹患有失智症之病患較偏好使用risperidone。本研究亦發現缺血性中風病患使用quetiapine相較於其他用藥組別時，其安全性較高，但仍需觀察性研究再進一步確認之。

Psychological complications are one of major problems to influence recovery after a stroke. In addition, when post-ischemic stroke patients are presence of these psychological problems could increase mortality risk. To treat these psychosis, antipsychotics were recommended as first-line therapy. However, there is concern about adverse effects of antipsychotics when prescribed for these patients. Nevertheless, there is limited literature providing epidemiologic information related with antipsychotics use after stroke. Therefore, we aimed to conduct an epidemiological survey to depict prescribing pattern of antipsychotics in Taiwan. The research data source came from NHIRD and our results were divided into three parts. First part of this study indicated the incidence of antipsychotic prescriptions in patients with ischemic stroke was 49.6/1,000 person-year. Besides, risk factors would increase 1-year incidence of antipsychotic use including older age, depression, dementia, delirium, anxiety, congestive heart failure, epilepsy, Parkinson’s disease, chronic kidney disease, antidepressants, benzodiazepines and opioids. The second part of this study is analyzing the factors influencing antipsychotics choice in patients with ischemic stroke. The results revealed elderly patients with dementia and delirium were more likely to be treated by risperidone, and quetiapine was more likely to be prescribed for patient with depression. Moreover, patients with cardio-metabolic syndromes were propensity to be treated by first-generation antipsychotics. The third part of this study is treatment duration of antipsychotics. Quetiapine showed the longest duration, the lowest re-admission rate and the highest survival rate. In summarize above results, we provided evidence-based information to clinical practice for post-ischemic stroke patients using antipsychotics.

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