Oral antipsikotik kullanımına eklenmiş depo antipsikotik tedavisinin şizofreni hastalarının tedaviye uyumları üzerine etkisi
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Date
2009-09
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Küre İletişim Grubu
Abstract
Bu çalışmada oral antipsikotik tedavisine ek olarak depo antipsikotik kullanan şizofreni hastalarının tedaviye uyumlarının yalnızca oral antipsikotik kullananlarla karşılaştırılması hedeşendi. Yöntem: Bu çalışma ile, Uludağ Üniversitesi Tıp Fakültesi Psikiyatri polikliniğine 01 Ocak 1998-31 Aralık 2005 tarihleri arasında ilk başvurularını yapan şizofreni hastalarına ait dosya bilgileri geriye dönük olarak incelendi. Kayıtların değerlendirilmesi 01 Nisan 2007de sonlandırıldı. Bu sayede tüm hastaların en az 18 aylık zaman diliminde tedavide kalma sürelerinin değerlendirilmesi sağlanmış oldu. Araştırılan zaman aralığında polikliniğimize başvurmuş olan 274 hasta takip süresince; oral antipsikotik tedavisine ek olarak herhangi bir depo antipsikotik eklenmiş ve eklenmemiş olarak iki gruba ayrıldı. Tedaviye uyum ölçütü olarak başlanan antipsikotik tedavi rejimi altında kalma süresi (herhangi bir nedenle tedaviyi bırakma zamanı) ile en az 18 ay takip altında kalma oranları olarak alınmıştır. Bulgular: Hastaların 48 i (%17.5) ek depo antipsikotik kullanmaktaydı. Depo antipsikotik kullanan hastaların 26 sı zuklopentiksol (%54.1), 18 i (%37.5) şupentiksol, 3ü şufenazin (%6.25) ve 1 (%2.1) tanesi ise uzun etkili risperidon kullanmaktaydı. Takip öncesi depo antipsikotik kullanan ve kullanmayan grup arasında sosyodemografik veriler, hastalık başlangıç yaşı ve antipsikotik kullanma süreleri açısından anlamlı bir fark saptanmadı. Depo antipsikotik kullanan grubun takip öncesinde yaşadığı depreşme sıklığı (p=0.031) ve hastane yatış sayılarının (p=0.031) kullanmayanlara göre daha yüksek olduğu ancak takip sürecinde bu farklılığın ortadan kalktığı saptandı. Takip süresince depreşme sıklığı ve hastaneye yatış sayıları açısından iki grup arasında fark saptanmadı. Tedaviye uyum ölçütleri olarak kullanılan başlanan antipsikotik rejimi altında kalma süresi ve en az 18 ay boyunca takip altında kalma oranları açısından iki grup arasında anlamlı fark saptanmadı. Her iki grup arasında ek antikolinerjik, antidepresan, mizaç düzenleyici ve anksiyolitik ilaç kullanma oranları açısından fark saptanmadı. Sonuç: Bu çalışma şizofreni hastalarında, mevcut oral antipsikotik tedavisine ek olarak depo antipsikotik ilaç kullanımının tedaviye uyum üzerinde bir katkı sağlamadığını göstermektedir. Bununla beraber takip süresinde ek olarak depo antipsikotik alan grup ile sadece oral antipsikotik alan grup arasında hastaneye yatış ve depreşme oranları arasında istatistiksel fark kalmamış olması, depo antipsikotiklerin sık hastane yatışı gereken ve sık depreşme yaşayan hastalarda tedaviye katkı sağlayacağını düşündürmektedir.
Objective: This study aims to compare the effects of adding depot antipsychotic to oral antipsychotic regimen in schizophrenic patients with respect to sociodemographic, treatment characteristics and prognosis in outpatient practices. Method: In this study, charts of schizophrenic patients referred to the outpatient psychiatry clinic at the Medical School of Uludag University first time during 1998-2005 period were examined. The evaluation of medical records was concluded in April 2007, this enabled the assessment of the rate of discontinuation over a minimum of 18 months for all patients in the study. Socio-demographics, characteristics of the disorder, and treatment and prognosis of the patients were questioned. The recruited 274 patients were divided into two groups: The depot antipsychotic added and only oral antipsychotic regimen group. Compliance measures were "the time to all-cause medication discontinuation' and 'rate of discontinuation'. Results: Forty-eight (17.5%) of 274 patients were prescribed depot antipsychotics in addition to their ongoing oral oral antipsychotic regimen. Of the depot antipsychotic added patients 26 (54.1%) received zuclopenthixol deaconate, 18 (%37.5) received flupentixol, 3 (%6.25) received flufenazin deaconate (%6.25) and 1 (%2.1) received long-acting risperidone. There were no significant statistical differences between treatment groups in terms of sociodemographic variables, age of onset of the disorder, and duration of antipsychotic use prior to follow-up. The depot antipsychotic added patients had significantly higher number of relapses (p=0.031) and hospitalizations (p=0.031) in pre-depot antipsychotic period. However, there were no significant statistical differences during the study period between two groups in terms of rates of relapse and hospitalization. Time to all-cause medication discontinuation and rate of discontinuation did not differ between the groups. Also no significant differences were found between two groups in terms of anticholinergic, antidepressant, mood stabilizer and anxiolytics agent prescription rates. Conclusions: Adding depot antipsychotics to oral antipsychotic regimen did not improve treatment compliance in our study patients. However, rates of relapse and hospitalization which were significantly higher in depot and oral antipsychotic receiving patients did not differ between two groups during follow-up. Thus, we think the patients with higher rates of relapse and hospitalization may benefit from adding depot antipsychotics to oral antipsychotic regimens.
Objective: This study aims to compare the effects of adding depot antipsychotic to oral antipsychotic regimen in schizophrenic patients with respect to sociodemographic, treatment characteristics and prognosis in outpatient practices. Method: In this study, charts of schizophrenic patients referred to the outpatient psychiatry clinic at the Medical School of Uludag University first time during 1998-2005 period were examined. The evaluation of medical records was concluded in April 2007, this enabled the assessment of the rate of discontinuation over a minimum of 18 months for all patients in the study. Socio-demographics, characteristics of the disorder, and treatment and prognosis of the patients were questioned. The recruited 274 patients were divided into two groups: The depot antipsychotic added and only oral antipsychotic regimen group. Compliance measures were "the time to all-cause medication discontinuation' and 'rate of discontinuation'. Results: Forty-eight (17.5%) of 274 patients were prescribed depot antipsychotics in addition to their ongoing oral oral antipsychotic regimen. Of the depot antipsychotic added patients 26 (54.1%) received zuclopenthixol deaconate, 18 (%37.5) received flupentixol, 3 (%6.25) received flufenazin deaconate (%6.25) and 1 (%2.1) received long-acting risperidone. There were no significant statistical differences between treatment groups in terms of sociodemographic variables, age of onset of the disorder, and duration of antipsychotic use prior to follow-up. The depot antipsychotic added patients had significantly higher number of relapses (p=0.031) and hospitalizations (p=0.031) in pre-depot antipsychotic period. However, there were no significant statistical differences during the study period between two groups in terms of rates of relapse and hospitalization. Time to all-cause medication discontinuation and rate of discontinuation did not differ between the groups. Also no significant differences were found between two groups in terms of anticholinergic, antidepressant, mood stabilizer and anxiolytics agent prescription rates. Conclusions: Adding depot antipsychotics to oral antipsychotic regimen did not improve treatment compliance in our study patients. However, rates of relapse and hospitalization which were significantly higher in depot and oral antipsychotic receiving patients did not differ between two groups during follow-up. Thus, we think the patients with higher rates of relapse and hospitalization may benefit from adding depot antipsychotics to oral antipsychotic regimens.
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Keywords
Depot antipsychotics, Schizophrenia, Treatment compliance, Drugs, Prescription, Inpatients, Disorder, Relapse, Pharmacology & pharmacy, Psychiatry, Depo antipsikotik, Tedavi uyumu, Şizofreni
Citation
Eker, S. S. vd. (2009). "Oral antipsikotik kullanımına eklenmiş depo antipsikotik tedavisinin şizofreni hastalarının tedaviye uyumları üzerine etkisi". Klinik Psikofarmakoloji Bülteni, 19(3), 273-278.