Analiza odpustne farmakoterapije bolnikov z diagnozo prve epizode shizofrenije v Psihiatrični bolnišnici Idrija v letu 2022

Bergant, Kristan (author), Vovk, Tomaž (mentor), Bačar Bole, Cvetka (comentor)

Shizofrenija je huda psihična motnja, ki se pojavlja z različnimi kliničnimi fenotipi, za katero je značilno otopelo čustvovanje in izkrivljeno zaznavanje realnosti. Zdravila za zdravljenje shizofrenije so antipsihotiki. Namen retrospektivne klinične raziskave je bil pregledati in ovrednotiti ustreznost odpustne farmakoterapije bolnikov s prvo epizodo shizofrenije ali podobne psihoze, ki so bili leta 2022 hospitalizirani v Psihiatrični bolnišnici Idrija. V raziskavi smo ugotovili, da je zgolj 55,4 % oseb z antipsihotičnim zdravljenjem imelo predpisano odpustno farmakoterapijo v skladu s smernicami zdravljenja shizofrenije. Opazili smo, da se je klozapin pogosto uporabljal za zdravljenje shizofrenije, ki ni bila terapevtsko rezistentna. Kljub dejstvu, da smernice ne predvidevajo sočasne uporabe depo in peroralne oblike antipsihotika hkrati, smo to kombinacijo zabeležili pri 87,5 % bolnikov, ki so prejeli depo obliko antipsihotika. Farmakoterapijo za uporabo po potrebi je imelo predpisano 55,2 % bolnikov, med katerimi je 37,8 % takih, ki so le-to imeli ustrezno predpisano. Ustreznost predpisovanja zdravil z delovanjem na centralni živčni sistem s smernicami smo ugotovili pri 68,2 % bolnikov. Opazili smo, da je bilo le 16,5 % vseh antipsihotikov predpisanih v ustreznem odmerku glede na vrednost povprečnega dnevnega vzdrževalnega odmerka zdravila za njegovo glavno indikacijo pri odraslih. Pri pregledu odmerjanja zdravil glede na ledvično funkcijo nismo opazili nepravilnosti. Pri bolnikih s povečanimi vrednostmi jetrnih encimov je zaradi večjega tveganja za neželene učinke ob jemanju za jetra obremenjujočih zdravil potrebna velika previdnost pri odmerjanju in natančnejša ocena stopnje jetrne okvare s strani odgovornega zdravnika. Opazili smo, da je število potencialnih interakcij naraščalo z večanjem števila sočasno predpisanih zdravil. 86,6 % bolnikov z odpustno farmakoterapijo je imelo prisotno vsaj eno potencialno interakcijo, med njimi je bilo 40,3 % takih, ki so imeli prisotno potencialno interakcijo tipa X. Med vsemi zdravili jih je 8,7 % bilo predpisanih za uporabo izven uradne indikacije. 37,3 % bolnikov je imelo predpisano vsaj eno zdravilo brez ustrezne indikacije, hkrati pa smo opazili 11,9 % bolnikov pri katerih vsaj ena indikacija ni bila zdravljena. V prihodnje bi bilo smiselno večjo pozornost nameniti izbiri ustrezne farmakoterapije, ki bi bila skladna z veljavnimi smernicami, in boljši sledljivosti ter urejenosti zdravstvene dokumentacije bolnikov.

• Language: Slovenian
• Keywords: shizofrenija, antipsihotiki, odpustna farmakoterapija, smernice zdravljenja
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2023
• PID: 20.500.12556/RUL-151599
• Publication date in RUL: 12.10.2023

Secondary language

• Language: English
• Title: Analysis of discharge pharmacotherapy of patients diagnosed with first episode schizophrenia in Idrija Psychiatric Hospital in 2022

Abstract

Schizophrenia is a severe mental disorder that is presented with different clinical phenotypes characterized by blunted emotion and distorted perception of reality. Medicines used for the treatment of schizophrenia are antipsychotics. The purpose of the retrospective clinical research was to review and evaluate the adequacy of discharge pharmacotherapy of patients with a first episode of schizophrenia or similar psychosis who were hospitalized in the Idrija Psychiatric Hospital in 2022. In the research, we found that only 55,4 % of people with antipsychotic treatment had prescribed discharged pharmacotherapy in accordance with the guidelines for the treatment of schizophrenia. We have noted that clozapine is often used to treat the treatment-non-resistant type of schizophrenia. Despite the fact that the guidelines do not specify the concomitant use of a depot and an oral form of the antipsychotic, we recorded this combination in 87,5 % of patients that received a depot form of an antipsychotic. ‘’As needed’’ pharmacotherapy was prescribed to 55,2 % of patients. Only to 37,8 % of these patients ‘’as needed’’ pharmacotherapy was correctly prescribed. The appropriateness of prescribed drugs acting on the central nervous system with the guidelines was found in 68,2 % of patients. We observed that only 16,5 % of all prescribed antipsychotics were prescribed in an appropriate dose according to the value of the defined daily dose of the antipsychotic. We did not encounter any abnormalities when examining the dosage of drugs in relation to renal function. In patients with elevated liver enzyme levels, great caution in dosing and determination of the degree of liver damage by the appropriate physician is required because of the increased risk of adverse reactions when taking drugs that affect the liver. We observed that the number of potential interactions increases with the number of simultaneously prescribed drugs. 86,6 % of patients with discharge pharmacotherapy had at least one potential interaction present, among them 40,3 % have type X interaction. Among all drugs, 8,7 % were prescribed for off – label use outside the official indication. To 37,3 % of patients at least one drug without an appropriate indication was prescribed, while at the same time we observed 11,9 % of patients with at least one non-treated indication. In the future, it would be useful to pay more attention to the selection of appropriate pharmacotherapy, that complies with accordance to current guidelines, and to provide better traceability and organization of patients' medical documentation.

• Keywords: schizophrenia, antipsychotics, discharge pharmacotherapy, treatment guidelines