目標：美國食品藥品管制局2008年6月公告使用「典型」及「非典型」抗精神病藥物治療失智症的行為及精神症狀，可能增加死亡風險，但臨床上經常使用該類藥物來治療失智症的行為精神症狀，本研究目的為瞭解國內失智症老人使用抗精神病藥物之情形及影響使用典型/非典型藥物之相關因素。方法：以2005年全民健康保險資料庫中65歲以上失智症病人且使用抗精神病藥物者為對象，瞭解其使用典型或非典型藥物之情形。考慮同一醫師看診之病患有聚集性，因此使用廣義估計模式(GEE)控制同一醫師看診病患之相關性，以邏輯斯迴歸分析影響使用典型或非典型抗精神病藥物之相關因素。結果：我國失智症老人中有33.95%使用抗精神病藥物，有17.49%使用典型藥物；16.46%使用非典型藥物；失智症老人於私立醫院、非醫學中心、非精神科、年長醫師就診者使用「典型」抗精神病藥物的機率顯著較高。結論：國內失智症老人使用典型與非典型抗精神病藥物的比例相近，異於美國以使用非典型藥物為主，醫療機構及醫師特質是影響失智症老人使用抗精神病藥物之重要因素，建議國內藉由醫療網計畫、專科醫學會或醫師公會協助加強醫師繼續教育訓練，讓醫師能重視抗精神病藥物處方之用藥知識，以降低用藥比例。(台

Objectives: Although the FDA has notified healthcare professionals that both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychoses, antipsychotic medications are still widely used to
manage behavioral and psychological symptoms in dementia despite concerns about their safety. Therefore, the aim of this study was to investigate the prescription of and factors associated with the prescription of these agents for elderly patients with dementia in Taiwan. Methods:Data about patients older than 65 and diagnosed with dementia in 2005 were collected from the databases of National Health Insurance. The prescription rates for atypical and conventional antipsychotic drugs in ongoing and newly diagnosed dementia patients in 2005 were calculated. The factors associated with conventional or atypical antipsychotic prescriptions were analyzed by a generalized estimating equation (GEE) adjusted for the cluster effect and by logistic regression. Results: 14,637 of 83,701 (16.46%) and 13,777 of 83,701 (17.49%) dementia patients were prescribed for conventional and atypical antipsychotics, respectively. Physicians from public hospitals, not from medical centers, not psychiatrists and elder physicians prescribed typical antipsychotics significantly. Conclusions: The use rate of conventional and atypical antipsychotics
for patients with Dementia are equal in Taiwan, different from the U.S. The main factors of patients used conventional or atypical are hospitals and physicians’ characteristics. Educational effort to physicians to decrease the use of conventional and atypical antipsychotics is worth.