Feridun BÜLBÜL, Hilal KAYA, A. Haluk SAVAS, Bahadir DEMİR, Ihsan AKSOY, Gokay ALPAK, Ahmet UNAL

Uzun etkili tipik ve atipik antipiskotiklerin iki uçlu bozukluk hastalarında kullanımı: Geriye dönük dosya taraması

Amaç: İkiuçlu bozukluk (İUB) tanı ve tedavi sürecinde zorluklar içeren ve kronik seyir gösteren psikiyatrik bir bozukluktur. İUB idame tedavisinde en büyük sorunlardan biri ilaç uyumunun sağlanmasıdır. Uzun etkili enjektabl (UEE) antipsikotikler bu tür hastalarda ciddi avantajlar sağlamaktadır. Biz bu çalışmada, tipik ve atipik UEE antipsikotikleri tedavi öncesi ve sonrasındaki bir yıllık dönemde klinik özellikler, hastane yatış sayıları ve yan etkiler açısından ayrı ayrı karşılaştırmayı amaçladık. Yöntem: Çalışma evreni Gaziantep Üniversitesi Duygudurum Birimi’nde takip edilen 802 İUB hastasından oluşturuldu. Bu hastalardan 80’i tipik ya da atipik UEE antipsikotik kullanıyordu. Çalışma kriterlerini karşılayan sadece 31 hasta çalışmaya dahil edildi. Etkinlik; tedavi öncesi ve sonrası bir yıllık dönem içindeki KGI, YMDÖ, HAMD skorları (12 ay önce, 6 ay önce, tedavi ekleme zamanı, 6 ay sonra ve 12 ay sonra), hastaneye yatış oranları ve ortalama yıllık hecme sayıları karşılaştırılarak değerlendirildi. Bulgular: Çalışma örnekleminde UEE antipsikotik kullanım oranı %9.88 olarak tespit edildi. İdame tedavide UEE antipsikotiklerin yıllık ortalama atak sayısını azalttığı ve depresyondan ziyade manik atağı önlemede etkin olduğu gösterildi. Atipik antipsikotiklerin YMDÖ ve KGI skorlarını anlamlı oranda azalttığı tespit edilirken HAMD skorlarında anlamlı bir değişiklik gözlenmedi. Tipik antipsikotikler ile ise ölçek skorlarının hiçbirinde anlamlı bir değişiklik görülmedi. Tipik ve atipik UEE antipsikotikler yan etkiler açısından tedavi öncesi ve sonrasında karşılaştırıldığında anlamlı bir farklılık saptanmadı. Tartışma: Çalışmamız bizim bilgilerimize göre, İUB’de atipik ve tipik UEE antipsikotiklerin birlikte dahil edildiği ilk çalışmadır. Sonuç olarak; UEE antipsikotiklerin manik atak korumasında etkin olabileceği ve yan etkiler açısından da tedavi öncesi ve sonrasında bir değişikliğin olmadığı gösterilmiştir. Hasta sayısı artırılarak yapılacak yeni çalışmalarla çalışmamızın sonuçlarının tekrar edilmesine ihtiyaç vardır.

Anahtar Kelimeler:

uzun etkili antipsikotikler, tipik, atipik, iki uçlu bozukluk

Both typical and atypical long-acting injectable antipsychotics in bipolar disorder: a retrospective chart review

Objective: Bipolar disorder (BD) is a chronic psychiatric disorder which shows difficulties in the process of diagnosis and treatment. One of the biggest problems in BD maintenance therapy is to ensure medication compliance. Long-acting injectable (LAI) antipsychotic medications have important advantages in such cases. In this study we aimed to include both LAI atypical and typical antipsychotics and to compare the clinical status, number of hospitalization, and side effects of pre and post-treatment periods of one year separately. Methods: Our study sample was constituted of 802 BD patients whom are followed in Mood Disorders Unit of Gaziantep University. Among them 80 patients has been using typical or atypical LAI antipsychotics. In the context of the study criteria only 31 patients included in the study. Efficacy was assessed by the CGI, YMRS, HAMD scores of pre and post-treatment periods of one year (12 months ago, 6 months ago, treatment initiation time, 6 months later and 12 months later), by the rate of hospitalization, and by comparing the average number of mood episodes. Results: LAI antipsychotic usage rate was identified as 9.88% in the study sample. Both of the antipsychotics were shown to decrease the average number of episodes in one year, and effective in preventing manic episodes rather than depressive episodes. Atypical antipsychotics significantly decreased YMRS and CGI scores but a decrease in HAMD scores was not observed, whereas no significant changes were observed in all scale scores with typical antipsychotics. There were not any significant difference when typical and atypical LAI antipsychotics compared according to their side effects in pre and post-treatment periods. Discussion: To the best of our knowledge, this is the first study that atypical and typical LAI antipsychotics were both included. As a result, it was shown that LAI antipsychotics may be effective in the prevention of manic episodes and there were not any differences found in terms of pre and post-treatment side effects. The results of our study are needed to be repeated in new studies with increased number of patients.

Keywords:

long acting antipsychotics, typical, atypical, bipolar disorder,

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