Zehra UÇAR, Betül YILDIRIM, Safiye Zeynep TATLI, Erguvan Tuğba ÖZEL KIZIL

Şizofreni ve şizoafektif bozukluğu olan yaşlı ve genç hastalarda psikotrop ilaç tercihleri ve yan etkilerinin karşılaştırılması

tanılı yaşlı hastalarda (YH) genç hastalara (GH) kıyasla tercih edilen psikotrop ilaç tedavilerini ve bunların tolere edilebilirliğini araştırmaktadır. Gereç ve Yöntem: Çalışmaya son on yılda bir üniversite hastanesine başvuran şizofreni/şizoaffektif bozukluğu olan 154 YH ve 195 GH dahil edildi. Hastaların tıbbi kayıtları incelendi. Ayrıca her hastanın kullandığı antipsikotik ilaç türleri ve dozları, diğer psikotrop ilaçları kullanımı, şikayetlerinin devam etmesi, ilaç yan etkileri ve tedaviye uyumu incelendi. Bulgular: İkinci kuşak antipsikotik kullanımı GH'de daha yüksekti (GH’de %88, YH’de %80). Antipsikotik eşdeğer dozları YH’de 266.63 mg, GH’de 522.21 mg olup, GH’da daha yüksek bulunmuştur. Klozapin (YH’de %7, GH’de %37) ve duygudurum düzenleyici (YH’de %4.5, GH’de %18) kullanımı GH'de daha yüksekti. YH'de antipsikotik ilaçların doz azaltım oranı daha yüksekti (YH’de %52, GH’de %21.5). Gruplar antipsikotik doz azaltımı nedenleri açısından karşılaştırıldığında yan etkiler nedeniyle YH'de daha sık (GH’de %21.4, YH’de %40), GH'de remisyona bağlı doz azaltımı daha sıktı (GH’de %78.6, YH’de %60). Sonuç: YH'de daha düşük antipsikotik dozları, daha hafif semptomlar veya daha düşük tolere edilebilirlik olduğunu düşündürür. GH'de klozapin ve duygudurum düzenleyici kullanımının yüksek olması, YH'de daha sık görülen ekstrapiramidal, kardiyovasküler ve metabolik yan etkiler gibi yan etkilerden kaçınılması ile açıklanabilir.

Anahtar Kelimeler:

yaşlı, şizofreni, şizoafektif bozukluk, antipsikotikler, duygudurum düzenleyiciler

Comparison of psychotropic drug preferences and side effects in old and young patients with schizophrenia and schizoaffective disorder

Purpose: The current study investigates the preferred psychotropic drug treatments and their tolerability in elderly patients (EP) with a diagnosis of schizophrenia or schizoaffective disorder compared to younger patients (YP). Materials and Methods: The study included 154 EP and 195 YP with schizophrenia/schizoaffective disorder admitted to the outpatient unit at a university hospital in the last decade. The medical records of the patients were reviewed. The types and doses of antipsychotic drugs used by each patient, use of other psychotropic drugs, ongoing complaints, drug-related side effects and compliance with treatment were also examined. Results: Second generation antipsychotic use was higher in YP (88% in YP, 80% in EP). Antipsychotic equivalent doses were found 266.63 mg in EP, 522.21 mg in YP, that also higher in the YP group. The use of clozapine (7% in EP, 37% in YP) and mood stabilizers (4.5% in EP, 18% in YP) were higher in YP. There was a higher rate of dose reduction of antipsychotic drugs in EP (21.5% in YP, 52% in EP). When the groups were compared in terms of the reasons of antipsychotic dose reduction, it was more frequent in EP due to side effects (21.4% in YP, 40% in EP), while the dose reduction due to remission was more common in YP (78.6% in YP, 60% in EP) . Conclusion: Lower doses of antipsychotics in EP suggests milder symptoms or lower tolerability. The higher clozapine and mood stabilizer use in YP can be explained by avoiding side effects like extrapyramidal, cardiovascular and metabolic side effects that are more frequent in EP.

Keywords:

Elderly, schizophrenia, schizoaffective disorder, antipsychotics, mood stabilizers,

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1. Erol A, Kılıçaslan EE. Symptom pattern and clinical course in schizophrenia. In schizophrenia and other psychotic disorders (Eds Danacı AE Böke Ö, Saka MC, Erol A, Kaymak SU):13-29. Ankara, Turkish Psychiatric Association, 2018.
2. Lawrence RE, First MB. Psychopathology. In The american psychiatric association publishing textbook of schizophrenia second edition (Eds Lieberman JA, Stroup ST, Perkins DO, Dixon LB):35-52. Washington, 2020.
3. Ng B, Martinez S, Koh S, Tohen M, Gangwisch JE. Epidemiology. In The american psychiatric association publishing textbook of schizophrenia second edition (Eds Lieberman JA, Stroup ST, Perkins DO, Dixon LB):3-11. Washington, 2020.
4. Hjorthoj C, Sturup AE, McGrath JJ, Nordentoft M. Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry 2017; 4(4): 295-301.
5. Solomon HV, Sinopoli M, DeLisi LE. Ageing with schizophrenia: an update. Current Opinion in Psychiatry 2021; 34(3): 266-74.
6. Grundy EM, Murphy M. Population ageing in Europe. In Oxford Textbook of Geriatric Medicine (Eds Michel JP, Beattie BL, Martin FC, Walston JD):11-8. Oxford, 2017.
7. Cohen CI, Meesters PD, Zhao J. New perspectives on schizophrenia in later life: implications for treatment, policy, and research. Lancet Psychiatry 2015; 2(4): 340-50.
8. Binbay T, Ulas H, Elbi H, Alptekin K. The psychosis epidemiology in Turkey: A systematic review on prevalence estimates and admission rates. Turk Psikiyatri Dergisi 2011; 22(1).
9. Üçok A, Preventive treatments in schizophrenia and risk groups for psychosis. In schizophrenia and other psychotic disorders (Eds Danacı AE Böke Ö, Saka MC, Erol A, Kaymak SU):93-105. Ankara, Turkish Psychiatric Association, 2018.
10. Uchida H, Mamo DC. Dosing of antipsychotics in schizophrenia across the life-spectrum. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33(6): 917-20.
11. Taylor DM, Barnes TRE, Young AH (editors). Prescribing in older people. In The Maudsley Prescribing Guidelines in Psychiatry. 14th ed. New York: John Wiley&Sons, 2021, p. 601-78. 12. Sartorius N. The classification of mental disorders in the Tenth Revision of the International Classification of Diseases. European psychiatry 1991; 6(6): 315-22. 13. Miyamoto S, Merrill DB, Lieberman JA, Fleischacker WW, Marder SR. Antipsychotic drugs. Psychiatry 2008: 2161-201.
14. Sim K, Su A, Leong JY, Yip K, Chong MY, Fujii S, et al. High dose antipsychotic use in schizophrenia: findings of the REAP (research on east Asia psychotropic prescriptions) study. Pharmacopsychiatry 2004; 37(4): 175-9.
15. Leslie DL, Rosenheck RA. Use of pharmacy data to assess quality of pharmacotherapy for schizophrenia in a national health care system: individual and facility predictors. Medical care 2001: 923-33.
16. Mamo DC, Sweet RA, Roy Chengappa KN, Reddy RR, Jeste DV. The effect of age on the pharmacological management of ambulatory patients treated with depot neuroleptic medications for schizophrenia and related psychotic disorders. International journal of geriatric psychiatry 2002; 17(11): 1012-7.
17. Jeste DV, Lacro JP, Gilbert PL, Kline J, Kline N. Treatment of late-life schizophrenia with neuroleptics. Schizophrenia Bulletin 1993; 19(4): 817-30.
18. Uchida H, Suzuki T, Mamo DC, Mulsant BH, Tanabe A, Inagaki A, et al. Effects of age and age of onset on prescribed antipsychotic dose in schizophrenia spectrum disorders: a survey of 1,418 patients in Japan. The American Journal of Geriatric Psychiatry 2008; 16(7): 584-93.
19. Zolk O, Greiner T, Schneider M, Heinze M, Dahling V, Ramin T, et al. Antipsychotic drug treatment of schizophrenia in later life: Results from the European cross-sectional AMSP study. The World Journal of Biological Psychiatry 2021: 1-13.
20. Mukku SSR, Sivakumar P, Varghese M. Clozapine use in geriatric patients—Challenges. Asian journal of psychiatry 2018; 33: 63-7.
21. Malhi G, Adams D, Plain J, Coulston C, Herman M, Walter G. Clozapine and cardiometabolic health in chronic schizophrenia: correlations and consequences in a clinical context. Australas Psychiatry 2010; 18(1): 32-41.
22. Pridan S, Swartz M, Baruch Y, Tadger S, Plopski I, Barak Y. Effectiveness and safety of clozapine in elderly patients with chronic resistant schizophrenia. Int Psychogeriatr 2015; 27(1): 131-4.
23. Soh JF, Klil-Drori S, Rej S. Using lithium in older age bipolar disorder: special considerations. Drugs & aging 2019; 36(2): 147-54.
24. Close H, Reilly J, Mason JM, Kripalani M, Wilson D, Main J, et al. Renal failure in lithium-treated bipolar disorder: a retrospective cohort study. PLoS One 2014; 9(3): e90169.
25. Ljubic N, Ueberberg B, Grunze H, Assion HJ. Treatment of bipolar disorders in older adults: a review. Ann Gen Psychiatry 2021; 20(1): 45.
26. Smith JM, Baldessarini RJ. Changes in prevalence, severity, and recovery in tardive dyskinesia with age. Arch Gen Psychiatry 1980; 37(12): 1368-73. 27. González-Rodríguez A, Labad J, Seeman MV. Antipsychotic-induced hyperprolactinemia in aging populations: Prevalence, implications, prevention and management. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2020; 101: 109941.
28. Xu Y, Amdanee N, Zhang X. Antipsychotic-Induced Constipation: A Review of the Pathogenesis, Clinical Diagnosis, and Treatment. CNS Drugs 2021; 35(12): 1265-74.