Ahmet NALBANT, Aylin CAN, Huseyin Sehid BURHAN, Alparslan CANSİZ, Kaasım Fatih YAVUZ, Mehtap Arslan DELİCE, Erhan KURT

Tardive Dyskinesia in Long Term Hospitalized Patients with Schizophrenia

Uzun süreli ve yatırılarak izlenen şizofreni hastalarında tardiv diskineziAmaç: Tardiv diskinezi (TD) dopamin reseptör blokajı yapan ilaçlar tarafından ortaya çıkan bir grup geç başlangıçlı hareket bozukluğudur. Risk faktörleri arasında en çok suçlananlar yaş, kadın cinsiyet, birinci kuşak antipsikotikler ve uzun süreli ilaç kullanımıdır. Nöroleptik kullananların tümünde TD prevalans değerleri %20-50 olarak belirlenmiştir. TD'nin Türkiye'deki durumu hakkında yeterli çalışma bulunmamaktadır. Bu araştırma, uzun süredir yatmakta olan şizofreni hastalarında TD yaygınlığını araştırmayı amaçlamaktadır.Yöntem: Yaş, cinsiyet ve hastaların hem araştırma esnasında hem de geçmişte kullandıkları antipsikoitklerin türü (1./2. kuşak, karışık) ve süresi kaydedildi. Hastaları tardiv hareket bozuklukları açısından değerlendirmek amacıyla Anormal İstemsiz Hareketler Ölçeği kullanıldı. Simpson-Angus Ölçeği tardiv parkinsonizmi değerlendirmek amacıyla kullanıldı. Akatizi değerlendirmesi için Barnes Akatizi Ölçeği kullanıldı. Bulgular: Geçmişte en uzun süre kullanılan antipsikotik açısından ortalama süre 206.63 aydı. Katılımcıların 18'ine (%22.5) TD tanısı kondu. Hastaların hiçbirinde tardiv akatizi saptanmadı. Geçmişte en uzun süre kullanılan antipsikoitiğin tipi ile TD arasındaki ilişki istatistik olarak anlamlı bulunmadı. Aynı şekilde, halen kullanılan antipsikotik türüyle TD arasındaki ilişki de istatistik olarak anlamlı bulunmadı. TD ile yaş ortalamaları arasında istatistik olarak anlamlı bir ilişki saptandı.Sonuç: Uzun süreli ilaç kullanımı olan bir grupta %22.5 oranı, yine de, beklenenden düşüktür. Hastaların hastane ortamında ve sağlık çalışanları gözetiminde doğrudan ve yakın izlemde olmaları ve risk oluşturabilecek durumlara erken müdahale edilmesi bu durum için bir açıklama olabilir. 1. ve 2. kuşak antipsikotik kullanımıyla ile TD yaygınlığı arasında çalışmamızda istatistik olarak anlamlı fark bulunmamısı da bir diğer önemli bulgudur.

Uzun süreli ve yatırılarak izlenen şizofreni hastalarında tardiv diskinez

Tardive dyskinesia in long term hospitalized patients with schizophreniaObjective: Tardive dyskinesia (TD) is a group of delayed-onset iatrogenic movement disorders caused by dopamine receptor-blocking agents. TD prevalence is estimated as 20-50% of all patients treated with neuroleptics. This study aimed to investigate the prevalence rate of TD in long-term hospitalized patients with schizophrenia. Method: We recorded age, gender, duration and type (first/second generation or mixed) of medication both at the time of interview and over preceding years. Dyskinesia was assessed by using the Abnormal Involuntary Movements Scale (AIMS). We also used the Simpson-Angus Scale for tardive parkinsonism. Akathisia was measured using the Barnes Akathisia Rating Scale (BARS). Results: Mean duration of the longest used antipsychotic was 206.63 months. Probable TD was found in 18 (22.5%) of patients. None of the patients had tardive akathisia. Relation between type of the longest used treatment and prevalence of TD was not statistically significant. Relationship between type of ongoing treatment and prevalence of TD was not determined statistically significant either. There was a statistically significant relationship between the mean age and TD. Discussion: Despite very long duration of antipsychotic use, 22.5% rate of prevalence is still lower than expected. This can be explained that these patients are under direct and close follow-up of healthcare providers and in hospital conditions, so that risky conditions can be intervened rapidly. Another noteworthy finding of our study is that there is no statistically significant difference betwen first and second generation antipsychotic use and TD prevalence.

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