DENİZ CEYLAN TUFAN ÖZALP, Sinem YEŞİLYURT, Berna Binnur AKDEDE, Zeliha SAYIN, Köksal ALPTEKİN

Şizofreni tedavisinde çoklu antipsikotik kullanımının belirtiler, yan etkiler ve yaşam niteliği ile ilişkisi

Giriş: Şizofreni tedavisinde çoklu antipsikotik kullanımı yaygındır ve yıllar içinde yaygınlığında artış gözlenmektedir; ancak çoklu antipsikotik kullanımının şizofreni tedavisindeki yararı tartışmalıdır. Bu araştırmada, şizofreni tedavisinde çoklu antipsikotik kullanımının yaşam niteliği ile ilişkisinin incelenmesi amaçlanmıştır. Yöntem: DSM-IV şizofreni tanı ölçütlerini karşılayan 92 hasta kullandıkları ilaç sayısına göre çoklu antipsikotik kullanımı (ÇAK) ve tekli antipsikotik kullanımı (TAK) gruplarına ayrıldı. Yaşam niteliği Şizofreni Hastaları için Yaşam Niteliği Ölçeği (YNÖ), belirtilerin şiddeti Pozitif ve Negatif Sendrom Ölçeği (PNSÖ) ve Klinik Genel İzlenimler Ölçeği, antipsikotiklerin yan etkileri UKU Yan Etki Değerlendirme Ölçeği kullanılarak değerlendirildi. Bulgular: ÇAK grubunda YNÖ toplam puanı TAK grubundakinden anlamlı olarak düşük saptandı. Toplam antipsikotik dozları ve UKU Yan Etki Değerlendirme Ölçeğindeki uykululuk, distoni, sertleşme ve boşalma bozukluğu oranları ÇAK grubunda TAK grubundan yüksek olarak saptandı. PNSÖ negatif toplam puanının, YNÖ toplam puanı üzerinde doğrudan anlamlı bir etkisinin olduğu görüldü. Sonuç: ÇAK grubunda TAK grubuna göre daha düşük yaşam niteliği, daha şiddetli negatif belirtiler, daha sık antipsikotik yan etkisinin olduğu saptandı. Şizofreni hastalarında negatif belirtilerin varlığı, buna bağlı olarak belirtilerde istenilen iyileşmenin sağlanamaması klinisyenlerin çoklu antipsikotik kullanmaya yönelmelerine yol açıyor olabilir. Çoklu antipsikotik kullanımı hastaların yaşam niteliklerinde ve hastalık belirtilerinde istenen düzelmeyi sağlamadığı gibi, yüksek doz antipsikotik kullanımına ve yan etkilerde artışa neden olmaktadır. (Anadolu Psikiyatri Derg 2016; 17(6):433-441).

The associatons of the antipsychotic polypharmacy in schizophrenia treatment with the symptoms, side effects and the quality of life

Objective: Antipsychotic polypharmacy is widespread in schizophrenia treatment, and it has been observed to become more widespread over the years. However, the benefits of antipsychotic polypharmacy in schizophrenia treatment are controversial. The present study aims to investigate the relationship between antipsychotic polypharmacy and the quality of life. Methods: Ninety two patients who met DSM-IV criteria for schizophrenia were divided into monotherapy (MT) and polypharmacy (PP) groups with respect to their medications. The quality of life was assessed using the Quality of Life Scale (QLS), the severities of symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale, and the side effects of antipsychotics were assessed using the UKU Side Effect Rating Scale. Results: Total QLS scores in the PP group were significantly lower than those in the MP group. The total antipsychotic doses and the frequencies of the side effects including sedation, dystonia, erectile and ejaculation dysfunction were detected to be higher in the PP group in comparison to the MP group. Total QLS scores were found to be significantly subject to the direct influence of total PANSS negative scores. Conclusion: Poorer quality of life, more severe negative symptoms and more frequent antipsychotic side effects were observed in patients who were receiving antipsychotic polypharmacy, in comparison to patients who were receiving antipsychotic monotherapy. The presence of negative symptoms, and consequently lack of improvement in symptoms may lead clinicians to prefer antipsychotic polypharmacy. However, antipsychotic polypharmacy does not bring sufficient improvement in symptoms and quality of life, whereas it leads to higher antipsychotic doses and increased side effects.

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