Sodelovanje pri zdravljenju s predpisanimi zdravili pri žrtvah samomora z duševno motnjo v zahodni Sloveniji v časovnem obdobju 2015-2017

Sočan, Vesna (author), Kržan, Mojca (mentor), Zupanc, Tomaž (co-mentor)

Samomor je pogost vzrok prezgodnje smrti v zahodnem svetu, v Sloveniji pa je kljub upadu v zadnjih letih, še vedno nad evropskim povprečjem. Med zelo pomembne dejavnike tveganja za samomor sodijo zlasti duševne bolezni in odvisnosti od različnih substanc. V raziskavi smo se osredotočili na žrtve samomora, ki so imele v obdobju 5 let pred smrtjo najmanj enkrat predpisane antidepresive in/ali antipsihotike ter proučili, v kolikšni meri so v obdobju zadnjih 3 mesecev pred samomorom sledile predpisani terapiji. V retrospektivno raziskavo smo vključili 385 žrtev samomora iz zahodne Slovenije v obdobju od 1.1.2015 do 31.12. 2017. Podatke o spolu, starosti, načinu samomora, toksikološki in alkoholometrični analizi smo pridobili na Inštitutu za sodno medicino Medicinske fakultete v Ljubljani, podatke o predpisanih zdravilih z delovanjem na osrednje živčevje pa na Nacionalnem inštituta za javno zdravje. Sledenje predpisani terapiji smo proučili pri 179 žrtvah samomora. Glede na rezultate toksikološke analize smo ugotovili, da je predpisanemu zdravljenju ustrezno sledilo 43 oseb (25 %). V skupini s predpisanimi zdravili, ki delujejo na osrednje živčevje, sta bila povprečna starost in delež žensk večja kot med tistimi brez tovrstnih zdravil. Med spolom, načinom samomora, starostnimi skupinami, prisotnostjo oz. odsotnostjo somatske bolezni in različnimi odvisnostmi glede kompliance nismo ugotovili razlik. Ugotovili pa smo, da je delež tistih, ki so že kdaj prej skušali narediti samomor večji pri tistih, ki so imeli predpisane antidepresive in/ali antipsihotike. Zdravljenje duševne bolezni z učinkovinami iz ene farmakodinamske skupine v primerjavi z zdravljenjem s kombinacijo antidepresivov in antipsihotikov t.j. iz več farmakodinamskih skupin ni izkazalo statistično značilnega vpliva na komplianco. Statistično pomembne razlike v komplianci med tistimi, pri katerih je bilo sprememb zdravljenja manj in tistimi, pri katerih so bile tekom petih let več kot tri spremembe, nismo ugotovili. Opazili smo pogosto in večletno uporabo anksiolitikov, hipnotikov in sedativov pri vseh osebah s predpisanimi zdravili z delovanjem na osrednje živčevje. Ugotovili smo, da se zdravljenje z anksiolitiki, hipnotiki in sedativi ni skladalo s smernicami. Slaba sodelovalnost pri zdravljenju duševnih motenj predstavlja veliko oviro pri doseganju želenih kliničnih rezultatov in močno zviša tveganje za samomor. V prihodnosti bi bilo potrebno sodelovalnosti oseb z duševnimi motnjami posvetiti več pozornosti.

• Language: Slovenian
• Keywords: samomor, duševna motnja, sodelovalnost, komplianca
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-108697
• Publication date in RUL: 12.07.2019

Secondary language

• Language: English
• Title: Drug adherence of suicide victims with mental health disorder in Western Slovenia over the period 2015-2017

Abstract

Suicide is one of the leading causes of premature death in Western countries. In Slovenia rate of suicide is still above the European average. Risk for suicide is greater among those who suffer from psychiatric illness, particularly depressive or schizophrenic disorder. The focus of our study was evaluation of compliance of suicide victims with mental illness, who committed suicide in years 2015-2017, to prescribed antidepressants and/or antipsychotics. We included 385 suicide victims from western Slovenia in this retrospective 3 – year study (from 1.1. 2015 to 31.12.2017). Demographyc data (age, gender) toxicology findings, alcholometric analysis and other variables were provided by the Institute for Forensic Medicine of the Medical Faculty of Ljubljana. Data on prescribed medicines with effect on the central nervous system were provided by the National Institute for Public Health. Data analysis disclosed that drug adherence could be assessed in 179 victims of suicide who were prescribed antidepressants and/or antipsychotics at least five years before their death. We found out that only 43 (24 %) suicide victims with prescribed antidepressants and/or antipsychotics were compliant to the treatment up to three months before suicide. There was no statistical significant difference in adherence to antidepressants and antipsychotics in regard to gender, different age groups, additional/no chronic diseases, cancer and substance abuse. We found out that the proportion of those who had attempted suicide in the past was greater in the group of suicide victims with prescribed antidepressants and/or antipsychotics compared to to those with no therapy. Treatment of mental illness from one pharmacodynamic group versus treatment with a combination of antidepressants and antipsychotics, i.e. from several pharmacodynamic groups, had no statistically significant effect on compliance. We have also not found a significant relation between frequent therapy modifications and lesser adherence. Frequent and long-term use of anxiolytics, hypnotics, and sedatives was observed in suicide victims with prescribed medication with effect on the central nervous system. We concluded that treatment guidelines with anxiolytics, hypnotics and sedatives were not followed by the treating physicians. Poor adherence to prescribed therapy for mental illness represents a major impediment in achieving the desired clinical results and greatly increases the risk of suicide. In order to reduce suicidality, monitoring patient adherence among those who suffer from mental illnesses is of great importance.

• Keywords: suicide, mental illness, adherence, compliance