Şizofreni ve şizoafektif bozukluğu olan yaşlı ve genç hastalarda psikotrop ilaç tercihleri ve yan etkilerinin karşılaştırılması

Year 2022, Volume: 47 Issue: 4, 1463 - 1470, 28.12.2022

Zehra Uçar , Betül Yıldırım , Safiye Zeynep Tatlı , Erguvan Tuğba Özel Kızıl

https://doi.org/10.17826/cumj.1139145

Abstract

tanılı yaşlı hastalarda (YH) genç hastalara (GH) kıyasla tercih edilen psikotrop ilaç tedavilerini ve bunların tolere edilebilirliğini araştırmaktadır.
Gereç ve Yöntem: Çalışmaya son on yılda bir üniversite hastanesine başvuran şizofreni/şizoaffektif bozukluğu olan 154 YH ve 195 GH dahil edildi. Hastaların tıbbi kayıtları incelendi. Ayrıca her hastanın kullandığı antipsikotik ilaç türleri ve dozları, diğer psikotrop ilaçları kullanımı, şikayetlerinin devam etmesi, ilaç yan etkileri ve tedaviye uyumu incelendi.
Bulgular: İkinci kuşak antipsikotik kullanımı GH'de daha yüksekti (GH’de %88, YH’de %80). Antipsikotik eşdeğer dozları YH’de 266.63 mg, GH’de 522.21 mg olup, GH’da daha yüksek bulunmuştur. Klozapin (YH’de %7, GH’de %37) ve duygudurum düzenleyici (YH’de %4.5, GH’de %18) kullanımı GH'de daha yüksekti. YH'de antipsikotik ilaçların doz azaltım oranı daha yüksekti (YH’de %52, GH’de %21.5). Gruplar antipsikotik doz azaltımı nedenleri açısından karşılaştırıldığında yan etkiler nedeniyle YH'de daha sık (GH’de %21.4, YH’de %40), GH'de remisyona bağlı doz azaltımı daha sıktı (GH’de %78.6, YH’de %60).
Sonuç: YH'de daha düşük antipsikotik dozları, daha hafif semptomlar veya daha düşük tolere edilebilirlik olduğunu düşündürür. GH'de klozapin ve duygudurum düzenleyici kullanımının yüksek olması, YH'de daha sık görülen ekstrapiramidal, kardiyovasküler ve metabolik yan etkiler gibi yan etkilerden kaçınılması ile açıklanabilir.

Keywords

yaşlı, şizofreni, şizoafektif bozukluk, antipsikotikler, duygudurum düzenleyiciler

Comparison of psychotropic drug preferences and side effects in old and young patients with schizophrenia and schizoaffective disorder

Abstract

Purpose: The current study investigates the preferred psychotropic drug treatments and their tolerability in elderly patients (EP) with a diagnosis of schizophrenia or schizoaffective disorder compared to younger patients (YP).
Materials and Methods: The study included 154 EP and 195 YP with schizophrenia/schizoaffective disorder admitted to the outpatient unit at a university hospital in the last decade. The medical records of the patients were reviewed. The types and doses of antipsychotic drugs used by each patient, use of other psychotropic drugs, ongoing complaints, drug-related side effects and compliance with treatment were also examined.
Results: Second generation antipsychotic use was higher in YP (88% in YP, 80% in EP). Antipsychotic equivalent doses were found 266.63 mg in EP, 522.21 mg in YP, that also higher in the YP group. The use of clozapine (7% in EP, 37% in YP) and mood stabilizers (4.5% in EP, 18% in YP) were higher in YP. There was a higher rate of dose reduction of antipsychotic drugs in EP (21.5% in YP, 52% in EP). When the groups were compared in terms of the reasons of antipsychotic dose reduction, it was more frequent in EP due to side effects (21.4% in YP, 40% in EP), while the dose reduction due to remission was more common in YP (78.6% in YP, 60% in EP) .
Conclusion: Lower doses of antipsychotics in EP suggests milder symptoms or lower tolerability. The higher clozapine and mood stabilizer use in YP can be explained by avoiding side effects like extrapyramidal, cardiovascular and metabolic side effects that are more frequent in EP.

Keywords

Elderly, schizophrenia, schizoaffective disorder, antipsychotics, mood stabilizers

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