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Yıl:2009; Cilt: 19; Sayı: 3>> Özet
TAM METİN
Klinik Psikofarmakoloji Bülteni; 2009;19(3):254-261
Oral antipsikotik ilaç kullanımına uyumsuz şizofreni hastalarında uzun-etkili risperidon enjeksiyon tedavisinin etkinliğinin retrospektif olarak incelenmesi
C Akkaya, A Sarandol, VO Kotan, Ş Cangür, A Aydın, S Kırlı
Uludag Universitesi Tıp Fakültesi, Psikiyatri Anabilim Dalı, Bursa, Turkey
Amaç: Bu çalışmada, oral antipsikotik ilaç kullanımına uyum göstermeyen şizofreni hastalarında uzun-etkili risperidon enjeksiyon tedavisine uyum ve tedavi etkinliğinin belirlenmesi amaçlanmıştır. Yöntem: Mevcut oral antipsikotik tedavisine tam veya kısmi uyumsuzluğa bağlı relaps nedeniyle kliniğe yatırılmış olan 30 şizofreni hastası (12 erkek, ortalama yaş=36.1±9.5 yıl) retrospektif olarak incelenmiştir. Kısa Psikiyatrik Değerlendirme Ölçeği (BPRS), Pozitif Semptomları Değerlendirme Ölçeği (SAPS), Negatif Semptomları Değerlendirme Ölçeği (SANS) ve Simpson-Angus Ölçeği (SAS) değerlendirme amacıyla kullanılmış ölçeklerdir. Ortalama izlem süresi 236.1±121.0 (28?336) gündü. On bir hastada (%36.7) uzun etkili risperidon enjeksiyon tedavisiyle birlikte başlanan ek oral antipsikotik tedavi üçüncü risperidon enjeksiyonunu takiben kesilebilmişken (No-OAT grubu), 19 hastada (%63.3) ek oral antipsikotik tedaviye devam edildi (OAT grubu). Bulgular: Tüm hastalarda tedaviyi bırakma oranı %46.7 iken, bu oran OAT grubunda %45.5 ve No-OAT grubunda %47.4 (P=0.781) idi. Ortalama BPRS, SAPS, SANS ve SAS skorları izlem sürecinde belirgin olarak azaldı. Başlangıca göre BPRS skorlarındaki yüzdelik değişim açısından No-OAT grubunda 3, 6, 9, 10, 11, 12, 13, 15 ve 17. vizitlerde OAT grubuna göre daha fazla azalma olurken, SANS skorlarında No-OAT grubunda OAT grubuna göre 6 ve 10. vizitlerde daha fazla azalma oldu (Her ikisi için P<0.05). Tüm grup için ortalama uzun etkili risperidon dozu 46.9±6.7 mg idi, OAT ve No-OAT grupları ortalama doz açısından farklılık göstermedi (sırasıyla 49±9.8 ve 44±9.8, P = 0.292). Tartışma: Şizofreni hastalarının tedavisinde uzun etkili risperidon enjeksiyon tedavisi günlük klinik pratikte etkindir, ancak ağır ve kronik olgularda sıklıkla oral antipsikotik tedavi ile kombinasyona gerek duyulmaktadır. Ağır ve kronik şizofreni hastalarında uzun etkili risperidon tedavisinin tek başına etkinlik veya tedavi uyumu açısından herhangi bir üstünlüğü mevcut değildir.
The effectiveness of risperidone long-acting injection in oral antipsychotic non-adherent patients with schizophrenia: A retrospective study
Objective: To determine effectiveness and adherence to
risperidone long-acting injection (RLAI) in schizophrenic
patients who were non-adherent to oral antipsychotic
treatment.
Method: We retrospectively checked over 30
schizophrenic patients (12 males, mean age=36.1±9.5
[year]s) who were hospitalized for relapse of their disorder
due to non-adherence to oral antipsychotic drugs.
Assessment tools were Brief Psychiatric Rating Scale
(BPRS), Scale for Assessment of Positive Symptoms (SAPS),
Scale for Assessment of Negative Symptoms (SANS) and
Simpson-Angus Scale (SAS). Mean follow-up was
236.1±121.0 (28?336) days. For 11 patients (36.7%), oral
add-on antipsychotic treatment (OAT) was discontinued
after the 3rd injection of risperidone (No-OAT group); for
19 (63.3%), it was continued (OAT group).
Results: The proportion who discontinued medications
was 46.7% overall; it was 45.5% for OAT and 47.4% for No-
OAT groups (P=0.781). Mean BPRS, SAPS, SANS, and SAS
scores decreased significantly from baseline during followup.
The No-OAT group had a greater decrease (percent
change in BPRS from baseline) than the OAT group at the
3rd, 6th, 9th, 10th, 11th, 12th, 13th, 15th and 17th visits; for SANS, it
was greater at the 6th and 10th visits (P<0.05 for both). The
mean dose of RLAI was 46.9±6.7 mg, and this was similar
for OAT and No-OAT groups (49±9.8 and 44±9.8,
respectively, P = 0.292).
Conclusions: In daily clinical practice, long-acting
injectable risperidone is effective in schizophrenic patients,
but oral antipsychotic drugs are frequently needed to be
used together with RLAI in severe and chronic cases. RLAI
had no additional effectiveness or adherence advantage in
this study for patients with severe forms of schizophrenia.

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