Comparison between Fixed-dosed Therapy and Symptom-triggered Therapy for Alcohol Detoxification in a Psychiatric Setting

於精神科病房使用固定劑量及症狀導向療法處理酒精解毒之差異

范瓊月(Chiung-Yueh Fan)；陳喬琪(Chiao-Chicy Chen)；黃名琪(Ming-Chi Huang)

症狀導向 ； 固定劑量 ； 酒精解毒 ； 精神科 ； fixed-dosed ； symptom-triggered ； alcohol detoxification ； psychiatric setting ； benzodiazepine

台灣精神醫學

28卷3期（2014 / 09 / 01）

148 - 155+i

英文

背景：目前最常使用症狀導向或固定劑量的方式治療酒精戒斷症狀。本研究是在精神科病房中，比較使用症狀導向及固定劑量處理酒精戒斷症狀的療效及差異。方法：利用病歷回顧的方式，分析60位診斷符合DSM-IV-TR酒精依賴的病人（30位使用症狀導向治療、30位使用固定劑量治療）。比較兩組病人酒精戒斷症狀的改善程度及benzodiazepine的使用劑量。本研究以酒精戒斷臨床量表中文版（CIWA-Ar-C）評估並追蹤住院期間病人的酒精戒斷嚴重度。結果：雖然使用症狀導向療法的病人在入院首日之平均酒精戒斷症狀較固定劑量療法的病人嚴重（CIWA-Ar-C 15.2 vs. 9.4, p＜0.001)，但治療兩天後後兩組酒精戒斷嚴重度便呈現沒有差異。接受症狀導向療法的病人比固定劑量療法者使用顯著較少的benzodiazepine（前三日用量：10.3 ± 4.5 vs. 23.1 ± 9.0毫克；一週用量：18.0 ± 6.9 vs. 47 ± 18.8毫克, p＜0.001）。結論：相同於以往文獻中有關內科單位治療酒精戒斷症狀的結果，我們的研究顯示在精神科病房中，比較症狀導向療法與固定劑量療法，二者處理酒精戒斷症狀療效相當，但前者所開立的benzodiazepine總藥量顯著減少。

Objective: Benzodiazepine is the drug of choice in treating alcohol withdrawal syndrome (AWS). Fixed-dosed therapy (FDT) and Symptom-triggered therapy (STT) are the commonly used treatment strategies. In this study, we intended to assess the benefits of the newly introduced STT compared to FDT for AWS management in a psychiatric setting. Methods: We retrospectively reviewed the medical records of 60 admitted patients fulfilling DSM-IV-TR criteria for alcohol dependence. They were divided into two groups based on the alcohol detoxification regimen they received (30 patients each in STT and FDT). AWS severity was measured using a Chinese version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar-C). We also compared the total lorazepam dosages and the changes in CIWA-Ar-C scores. Results: We found that despite the first-day AWS severity being more severe in the STT group (CIWA-Ar-C 15.2 vs. 9.4, p ＜ 0.001), patients in the STT group received significantly less lorazepam dosage compared to the FDT group during detoxification (10.3 ± 4.5 vs. 23.1 ± 9.0 mg for Day 1-3; 18.0 ± 6.9 vs. 47 ± 18.8 mg for Day 1-7, p ＜ 0.001). Conclusion: Being consistent with previous reports that supported the advantage of STT in medical wards when managing AWS, our study provides evidence that STT is as effective as FDT for alcohol detoxification in psychiatric settings and associated with less doses of lorazepam.

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