Аннотация
Введение. Антипсихотические препараты имеют широкое применение в практике лечения психических расстройств как в период острого психотического состояния, так и на стадии поддерживающей терапии. В этой связи важным требованием при назначении антипсихотиков является соответствие медикаментозного лечения принципам рационального использования лекарственных препаратов. Несмотря на актуальность этих вопросов, изучение особенностей назначений психотропных препаратов амбулаторным больным в Азербайджане до настоящего времени не проводилось. Цель: исследование посвящено изучению применения антипсихотических препаратов в амбулаторной практике и определению факторов, влияющих на выбор дозы препаратов и использование полифармакотерапии.
Методы. В исследование вошли 253 пациента с различными психическими расстройствами, получающие амбулаторное лечение в Центре Психического Здоровья. Подвергавшиеся анализу переменные включали социодемографические характеристики, клинические данные, а также информацию о назначенном им лечении.
Результаты. Ни социодемографические, ни клинические факторы не оказывали существенного влияния на выбор препаратов. Подавляющее большинство амбулаторных больных получали терапию атипичными антипсихотиками, из которых наиболее часто назначался рисперидон. Дозы препаратов, как правило, были ниже рекомендованных, и лишь у 3.2 % больных отмечалось лечение относительно высокими дозами. Более высокие дозы лекарств ассоциировались с диагнозом «шизофрения» и применением полифармакотерапии. В свою очередь, психофармакотерапия ассоциировалась с применением традиционных нейролептиков.
Обсуждение результатов. Полученные результаты предполагают, что лечение в системе амбулаторной помощи предоставляет большие возможности для рационального использования антипсихотических препаратов и позволяет в значительной степени персонализировать фармакотерапию.
Библиографические ссылки
Ismayilov F. Mental health services in Azerbaijan. Bulletin of the Board of International Affairs of the Royal College of Psychiatrists, 2004, Issue 3, pp. 16–17. Available at: https://www.researchgate.net/publication/322374144_Mental_health_services_in_Azerbaijan/fulltext/5a56b6ec0f7e9bf2a536cec5/322374144_Mental_health_services_in_Azerbaijan.pdf?origin=publication_detail (Accessed 21 August 2018).
Rasulov A. R. Development of mental health system in Azerbaijan. Kazanskii meditsinskii jurnal – Kazan Medical Journal, 2017, V. 98, no. 4, pp. 656–661 (in Russian).
Rational use of Drugs: Report of the Conference of Experts, Nairobi, 25–29 November 1985. Geneva: World Health Organization, 1987. 329 p.
Fleischhacker W. W., Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. International Journal of Neuropsychopharmacology. 2014. V. 17, Issue 7, pp. 1083–1093. DOI: 10.1017/S1461145712000399
Saddichha S., Chaturvedi S. K. Clinical practice guidelines in psychiatry: More confusion than clarity? A critical review and recommendation of a unified guideline. ISRN Psychiatry, 2014. Article ID 828917. DOI: 10.1155/2014/828917
Paton C., Barnes T. R. E., Cavanagh M.-R, Taylor D., Lelliott P. High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing. The British Journal of Psychiatry, 2008, V. 192, Issue 6, pp. 435–439. DOI: 10.1192/bjp.bp.107.042895
Romstadt N., Wonson E. Outcomes comparison of long-acting injectable antipsychotic initiation in treatment-naïve veterans in the inpatient versus outpatient setting. The Mental Health Clinician, 2018, V. 8, no. 1, pp. 24–27. DOI: 10.9740/mhc.2018.01.024
Edlinger M., Rettenbacher M. A., Kemmler G., Biedermann F., Widschwendter C. G., Fleischhacker W. W., Hofer A. Prescribing practice in inpatients versus outpatients with schizophrenia initiating treatment with second-generation antipsychotics: A naturalistic follow-up study. Journal of Clinical Psychopharmacology, 2016, V. 36, Issue 6, pp. 621–627. DOI: 10.1097/JCP.0000000000000573
Barbui C., Biancosino B., Esposito E., et al. Factors associated with antipsychotic dosing in psychiatric inpatients: a prospective study. International Clinical Psychopharmacology, 2007, V. 22, Issue 4, pp. 221–225. DOI: 10.1097/YIC.0b013e3281084ea8
Harder D. W., Strauss J. S., Greenwald D. F., Kokes R. F., Ritzler B. A., Gift T. E. Life events and psychopathology severity: comparisons between psychiatric outpatients and inpatients. Journal of Clinical Psychology, 1989, V. 45, pp. 202–209.
Warnke I., Rössler W., Herwig U. Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services. BMC Psychiatry, 2011, V. 11, p. 120.
Tiihonen J., Walhbeck K., Lönnqvist J., et al. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ, 2006, V. 333, p. 224. DOI: 10.1136/bmj.38881.382755.2F
Harrow M., Jobe T. H., Faull R. N. Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine, 2012, V. 42, Issue 10, pp. 2145–2155. DOI: 10.1017/S0033291712000220
Offord S., Lin J., Wong B., Mirski D., Baker R. A. Impact of oral antipsychotic medication adherence on healthcare resource utilization among schizophrenia patients with Medicare coverage. Community Mental Health Journal, 2013, V. 49, Issue 6, pp. 625–629. DOI: 10.1007/s10597-013-9638-y
How to investigate drug use in health facilities: Selected drug indicators. Geneva: World Health Organization, 1993. 92 p.
Gaebel W., Riesbeck M., Janssen B., Schneider F., Held T., Mecklenburg H., Sass H. Atypical and typical neuroleptics in acute schizophrenia and related delusional disorders. Drug choice, switching and outcome under naturalistic treatment conditions. European Archives of Psychiatry and Clinical Neuroscience, 2003, V. 253, pp. 175–184.
Bernardo M., Coma A., Ibáñez C., Zara C., Bari J. M., Serrano-Blanco A. Antipsychotic polypharmacy in a regional health service: a population-based study. BMC Psychiatry, 2012, V. 12, p. 42. DOI: 10.1186/1471-244X-12-42
Satterthwaite T. D., Wolf D. H., Rosenheck R. A., Gur R. E., Caroff S. N. A meta-analysis of the risk of acute extrapyramidal symptoms with intramuscular antipsychotics for the treatment of agitation. The Journal of Clinical Psychiatry, 2008, V. 69 (12), pp. 1869–1879.
Zhang J.-P., Gallego J. A., Robinson D. G., Malhotra A. K., Kane J. M., Correll C. U. Efficacy and safety of individual second-generation vs first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. International Journal of Neuropsychopharmacology, Collegium Internationale Neuropsychopharmacologicum, 2013, V. 16, Issue 6, pp. 1205–1218. DOI: 10.1017/S1461145712001277
Gründer G., Heinze M., Cordes J., Mühlbauer B., Juckel G., Schulz C., Rüther E., Timm J. Effects of first-generation antipsychotics versus second-generation antipsychotics on quality of life in schizophrenia: a double-blind, randomised study. The Lancet Psychiatry, 2016, V. 3, Issue 8, pp. 717–729. DOI: 10.1016/S2215-0366(16)00085-7
Ponizovsky A. M., Marom E., Ben-Laish M., Barash I., Weizman A., Schwartzberg E. Trends in the use of antipsychotics in the Israeli inpatient population, 2004–2013. Israel Journal of Health Policy Research, 2016, V. 5, pp. 16. DOI: 10.1186/s13584-016-0074-7
Meltzer H. Y. New trends in the treatment of schizophrenia. CNS & Neurological Disorders – Drug Targets, 2017, V. 16, Issue 8, pp. 900–906. DOI: 10.2174/1871527316666170728165355
Li M. Antipsychotic-induced sensitization and tolerance: Behavioral characteristics, developmental impacts, and neurobiological mechanisms. Journal of Psychopharmacology, 2016, V. 30, Issue 8, pp. 749–770.
Hanssens L., De Hert M., Wampers M., et al. Pharmacological treatment of ambulatory schizophrenic patients in Belgium. Clinical Practice and Epidemiology in Mental Health, 2006, V. 2, p. 11. DOI: 10.1186/1745-0179-2-11
Buckley P. F., Correll C. U. Strategies for dosing and switching antipsychotics for optimal clinical management. The Journal of Clinical Psychiatry, 2008, V. 69, Suppl. 1, pp. 4–17.
Volavka J., Vevera J. Very long-term outcome of schizophrenia. The International Journal of Clinical Practice, 2018, V. 72, Issue 7, e13094. DOI: 10.1111/ijcp.13094
Moilanen J. M., Haapea M., Jääskeläinen E., Veijola J. M., Isohanni M. K., Koponen H. J., Miettunen J. Long-term antipsychotic use and its association with outcomes in schizophrenia – the Northern Finland Birth Cohort 1966. European Psychiatry, 2016, V. 36, pp. 7–14. DOI: 10.1016/j.eurpsy.2016.03.002
Uchida H., Suzuki T., Takeuchi H., Arenovich T., Mamo D. C. Low dose vs standard dose of antipsychotics for relapse prevention in schizophrenia: Meta-analysis. Schizophrenia Bulletin, 2011, V. 37, Issue 4, pp. 788–799. DOI: 10.1093/schbul/sbp149
Fisher M. D., Reilly K., Isenberg K., Villa K. F. Antipsychotic patterns of use in patients with schizophrenia: polypharmacy versus monotherapy. BMC Psychiatry, 2014, V. 14, p. 341. DOI: 10.1186/s12888-014-0341-5
McMillan S. S, Jacobs S., Wilson L., et al. Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points. BMC Psychiatry, 2017, V. 17, p. 139. DOI: 10.1186/s12888-017-1295-1
Rasulov A. R. Development of mental health system in Azerbaijan. Kazanskii meditsinskii jurnal – Kazan Medical Journal, 2017, V. 98, no. 4, pp. 656–661 (in Russian).
Rational use of Drugs: Report of the Conference of Experts, Nairobi, 25–29 November 1985. Geneva: World Health Organization, 1987. 329 p.
Fleischhacker W. W., Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. International Journal of Neuropsychopharmacology. 2014. V. 17, Issue 7, pp. 1083–1093. DOI: 10.1017/S1461145712000399
Saddichha S., Chaturvedi S. K. Clinical practice guidelines in psychiatry: More confusion than clarity? A critical review and recommendation of a unified guideline. ISRN Psychiatry, 2014. Article ID 828917. DOI: 10.1155/2014/828917
Paton C., Barnes T. R. E., Cavanagh M.-R, Taylor D., Lelliott P. High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing. The British Journal of Psychiatry, 2008, V. 192, Issue 6, pp. 435–439. DOI: 10.1192/bjp.bp.107.042895
Romstadt N., Wonson E. Outcomes comparison of long-acting injectable antipsychotic initiation in treatment-naïve veterans in the inpatient versus outpatient setting. The Mental Health Clinician, 2018, V. 8, no. 1, pp. 24–27. DOI: 10.9740/mhc.2018.01.024
Edlinger M., Rettenbacher M. A., Kemmler G., Biedermann F., Widschwendter C. G., Fleischhacker W. W., Hofer A. Prescribing practice in inpatients versus outpatients with schizophrenia initiating treatment with second-generation antipsychotics: A naturalistic follow-up study. Journal of Clinical Psychopharmacology, 2016, V. 36, Issue 6, pp. 621–627. DOI: 10.1097/JCP.0000000000000573
Barbui C., Biancosino B., Esposito E., et al. Factors associated with antipsychotic dosing in psychiatric inpatients: a prospective study. International Clinical Psychopharmacology, 2007, V. 22, Issue 4, pp. 221–225. DOI: 10.1097/YIC.0b013e3281084ea8
Harder D. W., Strauss J. S., Greenwald D. F., Kokes R. F., Ritzler B. A., Gift T. E. Life events and psychopathology severity: comparisons between psychiatric outpatients and inpatients. Journal of Clinical Psychology, 1989, V. 45, pp. 202–209.
Warnke I., Rössler W., Herwig U. Does psychopathology at admission predict the length of inpatient stay in psychiatry? Implications for financing psychiatric services. BMC Psychiatry, 2011, V. 11, p. 120.
Tiihonen J., Walhbeck K., Lönnqvist J., et al. Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ, 2006, V. 333, p. 224. DOI: 10.1136/bmj.38881.382755.2F
Harrow M., Jobe T. H., Faull R. N. Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine, 2012, V. 42, Issue 10, pp. 2145–2155. DOI: 10.1017/S0033291712000220
Offord S., Lin J., Wong B., Mirski D., Baker R. A. Impact of oral antipsychotic medication adherence on healthcare resource utilization among schizophrenia patients with Medicare coverage. Community Mental Health Journal, 2013, V. 49, Issue 6, pp. 625–629. DOI: 10.1007/s10597-013-9638-y
How to investigate drug use in health facilities: Selected drug indicators. Geneva: World Health Organization, 1993. 92 p.
Gaebel W., Riesbeck M., Janssen B., Schneider F., Held T., Mecklenburg H., Sass H. Atypical and typical neuroleptics in acute schizophrenia and related delusional disorders. Drug choice, switching and outcome under naturalistic treatment conditions. European Archives of Psychiatry and Clinical Neuroscience, 2003, V. 253, pp. 175–184.
Bernardo M., Coma A., Ibáñez C., Zara C., Bari J. M., Serrano-Blanco A. Antipsychotic polypharmacy in a regional health service: a population-based study. BMC Psychiatry, 2012, V. 12, p. 42. DOI: 10.1186/1471-244X-12-42
Satterthwaite T. D., Wolf D. H., Rosenheck R. A., Gur R. E., Caroff S. N. A meta-analysis of the risk of acute extrapyramidal symptoms with intramuscular antipsychotics for the treatment of agitation. The Journal of Clinical Psychiatry, 2008, V. 69 (12), pp. 1869–1879.
Zhang J.-P., Gallego J. A., Robinson D. G., Malhotra A. K., Kane J. M., Correll C. U. Efficacy and safety of individual second-generation vs first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. International Journal of Neuropsychopharmacology, Collegium Internationale Neuropsychopharmacologicum, 2013, V. 16, Issue 6, pp. 1205–1218. DOI: 10.1017/S1461145712001277
Gründer G., Heinze M., Cordes J., Mühlbauer B., Juckel G., Schulz C., Rüther E., Timm J. Effects of first-generation antipsychotics versus second-generation antipsychotics on quality of life in schizophrenia: a double-blind, randomised study. The Lancet Psychiatry, 2016, V. 3, Issue 8, pp. 717–729. DOI: 10.1016/S2215-0366(16)00085-7
Ponizovsky A. M., Marom E., Ben-Laish M., Barash I., Weizman A., Schwartzberg E. Trends in the use of antipsychotics in the Israeli inpatient population, 2004–2013. Israel Journal of Health Policy Research, 2016, V. 5, pp. 16. DOI: 10.1186/s13584-016-0074-7
Meltzer H. Y. New trends in the treatment of schizophrenia. CNS & Neurological Disorders – Drug Targets, 2017, V. 16, Issue 8, pp. 900–906. DOI: 10.2174/1871527316666170728165355
Li M. Antipsychotic-induced sensitization and tolerance: Behavioral characteristics, developmental impacts, and neurobiological mechanisms. Journal of Psychopharmacology, 2016, V. 30, Issue 8, pp. 749–770.
Hanssens L., De Hert M., Wampers M., et al. Pharmacological treatment of ambulatory schizophrenic patients in Belgium. Clinical Practice and Epidemiology in Mental Health, 2006, V. 2, p. 11. DOI: 10.1186/1745-0179-2-11
Buckley P. F., Correll C. U. Strategies for dosing and switching antipsychotics for optimal clinical management. The Journal of Clinical Psychiatry, 2008, V. 69, Suppl. 1, pp. 4–17.
Volavka J., Vevera J. Very long-term outcome of schizophrenia. The International Journal of Clinical Practice, 2018, V. 72, Issue 7, e13094. DOI: 10.1111/ijcp.13094
Moilanen J. M., Haapea M., Jääskeläinen E., Veijola J. M., Isohanni M. K., Koponen H. J., Miettunen J. Long-term antipsychotic use and its association with outcomes in schizophrenia – the Northern Finland Birth Cohort 1966. European Psychiatry, 2016, V. 36, pp. 7–14. DOI: 10.1016/j.eurpsy.2016.03.002
Uchida H., Suzuki T., Takeuchi H., Arenovich T., Mamo D. C. Low dose vs standard dose of antipsychotics for relapse prevention in schizophrenia: Meta-analysis. Schizophrenia Bulletin, 2011, V. 37, Issue 4, pp. 788–799. DOI: 10.1093/schbul/sbp149
Fisher M. D., Reilly K., Isenberg K., Villa K. F. Antipsychotic patterns of use in patients with schizophrenia: polypharmacy versus monotherapy. BMC Psychiatry, 2014, V. 14, p. 341. DOI: 10.1186/s12888-014-0341-5
McMillan S. S, Jacobs S., Wilson L., et al. Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points. BMC Psychiatry, 2017, V. 17, p. 139. DOI: 10.1186/s12888-017-1295-1