Abdülkadir TABO, Erkan AYDIN, K. Oğuz KARAMUSTAFALIOĞLU, Hüseyin YUMRUKÇAL, U Erman UZUN, M. Cansu ÜLGEN

Bir toplum ruh sağlığı merkezinin antipsikotik polifarmasisi üzerine etkisi: Şizofreni hastalarının 12 aylık izlenmesi

Amaç: Şizofrenide tedavi uyumsuzluğuna bağlı çoklu antipsikotik tedavisi, metabolik yan etkiler ve yüksek ölüm nedeniyle ancak son çare olarak önerilmektedir. Diğer yandan, klinik uygulamada çoklu antipsikotik kullanımı yaygındır. Bir toplum ruh sağlığı merkezindeki aktivitelerin (TRSM) orada kayıtlı şizofreni hastalarının klinik belirtileri ve çoklu antipsikotik ilaç kullanımı üzerine etkileri, şizofreni tedavisi açısından nasıl değişkenler olduğunu belirlemek üzere incelenmiştir. Yöntem: Bir yıl boyunca burada izlenen 120 hastanın sosyodemografik veri formları, Şizofrenide Pozitif ve Negatif Belirti Ölçeği (PANNS) puanları, İlaç Uyumu Ölçeği sonuçları ve ilaç kullanımı geriye dönük olarak değerlendirilmiştir. Bulgular: Hastaların bütün PANSS alt ölçek puanlarının (pozitif, negatif ve genel) azaldığı, ilaç uyumlarının arttığı, antipsikotik polifarmasisi (APP) oranlarının değişmediği ve ortalama ilaç tedavi dozlarının da değişmediği saptanmıştır. Sonuç: Hastaların belirti ve uyumlarında artış olduğu halde APP'de ısrarcı olunması, bir yandan toplum ruh sağlığı aktivitelerinin sürdürülmesinin, diğer yandan psikiyatristlerin reçete yazma alışkanlıklarına yapılacak bir müdahalenin önemini göstermektedir. Reçete yazma alışkanlıklarına müdahale, çoklu ilaç kullanımında azalma sağlayabilir. Sonuçlar, şizofreninin psikofarmakoterapisinin etkinliğini artırmada, toplum ruh sağlığı merkezi hizmetlerinden yararlanmanın gerekliliğine işaret etmektedir.

The effects of one community mental health center on antipsychotic polypharmacy: 12-months follow-up of patients with schizophrenia

Objective: Treatment with multiple antipsychotic medications (antipsychotic polypharmacy-APP) in schizophrenia is recommended to be considered as a last resort, due to non-compliance, metabolic side effects and high mortality. On the other hand, in current clinical practice, APP is quite commonplace. The effects of one 'community mental health center' (CMHC) activities on APP and clinical symptoms of enrolled schizophrenia patients were investigated in order to determine changes on antipsychotic treatment processes for schizophrenia. Methods: Sociodemographic Data Form, Positive and Negative Symptom Scale for Schizophrenia (PANSS) scores, Pharmacotherapy Compliance Scale evaluations and modes of medication utilization of 120 patients who were followed-up in this center for one year were evaluated retrospectively. Results: All PANSS subscale (positive, negative and general) scores of the patients decreased and compliance with drug treatment increased; rates of APP remained the same and mean drug treatment doses did not change. Conclusion: The insistence on APP, in spite of improvements in symptoms and patient compliance, shows the importance of maintaining community mental health activities as well as interventions targeting prescription habits of psychiatrists. Such interventions can provide a decrease in use of multiple medications. Results indicate the need to utilize community mental health center services to increase the effectiveness of psychopharmacotherapy for schizophrenia.

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