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Yıl:2000; Cilt: 1; Sayı: 2>> Özet
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Anadolu Psikiyatri Dergisi; 2000;1(2):100-106
Antipsikotik ilaç tedavisinde uyum problemleri: Bunların ekstrapiramidal yan etkilerle ilişkisi
S Sofuoğlu, MT Turan
Erciyes Ü.T.F. Psikiyatri ABD, Kayseri
“Tedaviye uyum” veya daha yeni bir terim ile “tedaviyi destekleme” davranış üzerinde gözlenen etkinin verilen tedavinin standartlarına oranı olarak ifade edilir. “Kompliyans” terimi sadece farmakolojik tedaviye uyumu değil, tedavinin süresi, hasta veya hastalık ile ilişkili değişkenler ve diğer psikososyal özellikler gibi tedaviye karışan diğer faktörlere uyumu da kapsar. Bundan başka ekstrapiramidal motor yan etkiler, sedasyon, kilo artışı ve cinsel disfonksiyonu içine alan yan etkilerin antipsikotik tedaviye uyumu önemli şekilde değiştirdikleri bilinmektedir. Antipsikotik alan hastaların yaklaşık 1/3’ünün ilaç tedavisine tam uyumlu, 1/3’ünün kısmen uyumlu, geri kalanların ise uyumsuz oldukları birçok çalışma ile ortaya konmuştur. Fakat hastalar tedavide zaman geçtikçe daha uyumlu olma eğilimi göstermektedirler. Önemli bir husus da uyumsuzluğun daima hastanın kusuru olmamasıdır. Birçok hasta doktorların baskıcı, katı ve empatiden yoksun tutumlarından rahatsızdır. Psikiyatristler 1) İyi bir doktor-hasta ilişkisi tesis ederek 2) Hastayı ilaçların tabiatı ve riskleri hakkında bilgilendirerek 3) İlaç tolerabilitesinde önemli bireysel farklılıklar olabileceğini dikkate alarak 4) Yan etkileri iyi tanıyıp, yan etkilerini tedavi ederek tedaviye uyumu önemli oranda düzeltebilirler.
Problems of comliance with antipsychotic drugs: In relation to their extrapyramidal side effects
“Compliance” (or a more recent term “adherecence”) is expressed as the ratio between an observed treatment behavior and given treatment standards. The term “compliance” applies not only to pharmacologic treatment but also to all kinds of other factors involved in the treatment such as type and duration of treatment, patient-and illness-related variables and other psychosocial features. Furthermore, side effects including extrapyramidal motor adverse effects, sedation, weight gain and sexual dysfunction are known to exert a significant influence on the compliance with antipsychotic treatment. It has been demontrated in a number of studies that only about one third of all patients are fully compliant with drug treatment. Another one third is only partially compliant. The remaining patients fail to take drugs from time to time. But over time, patients tend to become highly compliant in their clinic attendance. It is important to note that noncompliance is not always the patient’s fault. Many patients have problems with authoritarian, rigid and nonempathetic attitudes of the doctors. Psychiatrists may make the compliance considerably improved by 1) establishing a good doctor-patient relationship 2) adequately informing the patient about the risk and the nature of side effects of the drugs 3) taking the individual differences in drug tolerability into account 4) recognizing and treating side effects.

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