Analiza farmakoterapije hospitaliziranih bolnikov s shizofrenijo in podobnimi psihozami

Bačar Bole, Cvetka (author), Vovk, Tomaž (mentor)

Antipsihotiki so ključna zdravila za zdravljenje shizofrenije in podobnih psihoz. Zaradi neželenih učinkov in interakcij zdravil predstavlja njihova uporaba določeno tveganje za bolnika. V okviru doktorske disertacije smo načrtovali in izvedli 16–mesečno prospektivno, opazovalno in ne-intervencijsko klinično raziskavo v Psihiatrični bolnišnici Idrija ter tako dobili vpogled v predpisovanje zdravil hospitaliziranim bolnikom s shizofrenijo in podobnimi psihozami. Poleg farmakoterapije smo analizirali tudi značilnosti preiskovane populacije (311 bolnikov). Dokazali smo, da bolniki s shizofrenijo in podobnimi psihozami zaradi značilnosti svoje bolezni kot tudi zaradi pridruženih bolezni in obvladovanja neželenih učinkov antipsihotikov prejemajo več različnih zdravil. Petina predpisov je vsebovala ne-psihotropna zdravila. Analiza farmakoterapije je pokazala, da antipsihotiki, po pričakovanju največkrat uporabljena zdravila, niso bili vedno predpisani v sladu s priporočili (velik delež uporabe klasičnih antipsihotikov, uporaba premajhnih odmerkov, sočasna uporaba več antipsihotikov, predpisovanje za uporabo po potrebi). Dokazali smo, da pri bolnikih s shizofrenijo in podobnimi psihozami zaradi različnih vzrokov pogosto prihaja do zamenjav antipsihotikov (37 %). Nekaterih rezultatov nismo pričakovali: interakcije zdravil niso bile nikoli vzrok zamenjave antipsihotikov, največkrat je bila izvedena takojšnja zamenjava antipsihotikov, ki večinoma ni priporočljiva, več kot 10 % zamenjav antipsihotikov je bilo izvedenih na bolnikovo željo in v zamenjavo so bili vključeni trije ali več antipsihotikov. Potrdili smo, da so bolniki s shizofrenijo in podobnimi psihozami zaradi polifarmakoterapije izpostavljeni velikemu tveganju za potencialne interakcije tipa X in tipa D (88,7 %), več kot polovica bolnikov je imela predpisano neustrezno kombinacijo zdravil, v katero so bili vključeni predvsem antipsihotiki (potencialne interakcije tipa X), ter da obstaja močna povezava med številom predpisanih zdravil in vsemi klinično opaženimi skupinami simptomov in znakov (OR 2.85; 95% CI 1.84–5.73). Izsledki raziskave potrjujejo, da je potrebno načrtovati neodvisne, prospektivne raziskave s področja predpisovanja/uporabe zdravil pri hospitaliziranih psihiatričnih bolnikih. Pomembna je tudi ugotovitev, da lahko z vključitvijo kliničnega farmacevta v proces zdravljenja izboljšamo kakovost bolnišnične obravnave psihiatričnih bolnikov.

• Language: Slovenian
• Keywords: hospitalizirani bolniki, shizofrenija in podobne psihoze, farmakoterapija, antipsihotiki, interakcije med zdravili
• Work type: Doctoral dissertation
• Organization: FFA - Faculty of Pharmacy
• Year: 2023
• PID: 20.500.12556/RUL-146142
• Publication date in RUL: 21.05.2023

Secondary language

• Language: English
• Title: Analysis of pharmacotherapy in hospitalized patients with schizophrenia spectrum disorders

Abstract

Antipsychotics are the most important drugs for the treatment of schizophrenia spectrum disorders. Due to adverse reactions and drug–drug interactions, the use of antipsychotics poses a risk to the patients. As part of the doctoral dissertation, we planned and carried out a 16-month prospective, observative, and non-interventional clinical study in the Psychiatric Hospital Idrija to determine the use of all drugs in a specific population of psychiatric patients. We analysed characteristics and pharmacotherapy of the investigated population (311 patients). We demonstrated that patients receive several different drugs due to the characteristics of psychiatric disorder as well as comorbidities and the management of adverse effects of antipsychotics. 20 % of the prescriptions contained non-psychotropic drugs. The analysis of pharmacotherapy showed that antipsychotics were not always prescribed in accordance with the guidelines (high use of classic antipsychotics, use of underdoses, receiving several antipsychotics at the same time, prescribing pro re nata). We have shown that patients often switch antipsychotics (37 %) due to various reasons. Some results were not expected: drug interactions were never the cause of switching antipsychotics, abrupt switching was most often performed, which is mostly not recommended, more than 10 % of switches were performed at the patient's request and three or more antipsychotics were included in the switching. The prevalence of potential interactions of type X and type D was high (88.7 %), and more than half of patients were exposed to at least one drug combination that should be avoid (interaction of type X). We found out associations between all clinically observed symptoms and signs and several variables, including potential interactions. The dominant variable associated with all groups of symptoms and signs was the number of drugs that patients received (OR 2.85; 95% CI 1.84–5.73). The results of the study confirm the need to plan independent, prospective studies in the field of prescribing/use of drugs in hospitalised psychiatric patients. It is also important to conclude that by including a clinical pharmacist in the treatment process, we can improve the quality of hospital treatment for psychiatric patients.

• Keywords: inpatients, schizophrenia spectrum disorders, pharmacotherapy, antipsychotics, drug-drug interactions