| Abstract | CILJ ISTRAŽIVANJA:
Ispitati utjecaj terapije osnovne bolesti (risperidon per os) i terapije hipnoticima (zolpidem) na kliničku sliku nesanice u shizofrenih bolesnika. Terapija hipnoticima dovodi do značajnijeg popravka kliničke slike nesanice, u odnosu na terapiju osnovne bolesti.
USTROJ ISTRAŽIVANJA:
Provedena je prospektivna studija u trajanju od travnja 2011. do ožujka 2012. Glavni uključujući kriteriji bili su dijagnoza shizofrenije po MKB-10, klinička slika nesanice pri prijemu prema Hamiltonovim pitanjima o nesanici i rezultat veći od 5 prema Pittsburškom indeksu kvalitete spavanja.
Bolesnike smo podijelili u dvije skupine, jedna je primala peroralnu terapiju risperidonom, a drugoj smo uz terapiju risperidonom ordinirali hipnotik zolpidem. Nakon provedenog liječenja, ponovo smo zadnji dan hospitalizacije procjenjivali kliničku sliku nesanice.
MJESTO ISTRAŽIVANJA:
Istraživanje je provedeno na Klinici za psihijatriju KBC-a Split.
SUDIONICI:
Istraživanje je uključivalo 40 ispitanika koji su hospitalizairani na odjelu psihijatrije kliničkog bolničkog centra Split i kojima je u vremenu od travnja 2011. do ožujka 2012. ordinirana terapija risperidonom per os, te polovici hipnotikom zolpidemom uz risperidon.
GLAVNE MJERE ISHODA:
Od ukupnog broja od 40 bolesnika sa kliničkom slikom shizofrenije svi su bili na terapiji oralnog risperidona. Nakon procjene kliničke slike nesanice prvi dan hospitalizacije, polovici je ordinirana uz terapiju risperidonom i terapija hipnotikom zolpidemom. Učinkovitost terapije osnovne bolesti i terapije hipnoticima na kliničku sliku nesanice kod shizofrenih bolesnika provjerili smo zadnji dan hospitaliracije ponovnim provođenjem upitnika o kvaliteti spavanja. Doza lijekova se titrirala u skladu s kliničkom slikom. Korištene doze su za oralni risperidon 2, 4, 6 i 12 mg, a zolpidema 10 i 15 mg. Ispitivali smo poboljšanje kliničke slike nesanice kod bolesnika liječenih terapijom osnovne bolesti u odnosu na bolesnike liječene hipnotikom.
REZULTATI:
Rezultati su pokazali kako su obe vrste terapije koje smo provodili djelotvorne. Primijećeno je statistički značajno poboljšanje kod obje skupine bolesnika u odnosu na pitanja iz Hamiltonove ljestvice, kao i u odnosu na Pittsburški indeks kvalitete spavanja (Tablice 2 i 3). Svi ispitanici, bez obzira na terapiju koju su primali, značajno su poboljšali kvalitetu spavanja (M = 4.75, ±0.28 – aritmetička i standardna devijacija spavanja u zadnjem mjerenju, za razliku od prvog mjerenja M=13.2,± 0.43). Uzimajući u obzir da skupine bolesnika nisu imale jednako tešku kliničku sliku nesanice prvi dan hospitalizacije, značajnije poboljšanje pokazuje skupina bolesnika koja je primala hipnotik uz terapiju osnovne bolesti. Ovaj rezultat se jasno vidi iz razlike u skokovima ocjena kod obje skupine (Graf 1 i 2). U prvoj skupini s dva lijeka zabilježen je skok od 16 (prosječne ocjene) na 4, dok je u drugoj skupini s jednim lijekom skok ocjena manji, od 10 na 5.
ZAKLJUČCI:
Liječenje nesanice u shizofrenih bolesnika terapijom osnovne bolesti, kao i liječenje uz ordiniranje hipnotika vrlo je učinkovito. Liječenje ordiniranjem hipnotika, u skladu s hipotezom ovog istraživanja, daje bolje rezultate. Klinička slika nesanice se značajnije popravlja primjenom ovog načina liječenja. |
| Abstract (english) | OBJECTIVE:
To examine the influence of underlying disease (risperidon per os) therapy and hypnotics (zolpidem) in the clinical picture of insomnia in schizophrenic patients. Treatment of hypnotics leads to significant repair clinical insomnia, compared to the treatment of primary disease.
DESIGN:
We conducted a prospective study lasting from April 2011. until March 2012. Including the main criteria were diagnosis of schizophrenia according to MKB-10 clinical insomnia at admission to the Hamiltonian questions about insomnia and the result is greater than 5 the Pittsburgh sleep quality index. Patients were divided into two groups, one receiving oral treatment with risperidone, while the second are with risperidone therapy were prescribed hypnotic zolpidem. After the treatment, again the last day of hospitalization, we evaluated the clinical insomnia.
SETTINGS:
The study was conducted at the Department of Psychiatry, Clinical Hospital Split.
PARTICIPANTS:
The study included 40 patients who were hospitalized at the Department of Psychiatry, Clinical Hospital Center Split, which is the period from April 2011. until March 2012. applied therapy with risperidone orally, and half of the hypnotic zolpidem with risperidone therapy.
MAIN OUTCOME MEASURES:
Of the total number of 40 patients with clinical features of schizophrenia were all treated with oral risperidone. After clinical assessment of insomnia the first day of hospitalization, half of patients the administered treatment with risperidone therapy and hypnotics zolpidem. The effectiveness of treatment of the underlying disease and therapy hypnotics in clinical insomnia in schizophrenic patients, we checked the last day of hospitalization re-implementation questionnaires on quality of sleep. Doses of drugs are titrated according to clinical picture. Doses used for oral risperidone 2, 4, 6 and 12 mg, zolpidem 10 and 15 mg. We investigated the improvement of clinical symptoms of insomnia in patients treated with underlying disease compared to patients treated with hypnotics.
RESULTS:
Results showed that both types of therapies are effective. Observed a statistically significant improvement in both patient groups with respect to questions of Hamilton scale, and to the Pittsburgh sleep quality index (Table 2, 3). All respondents, regardless of the treatment they received, were significantly improved sleep quality (M= 4.75, ± 0.28 - arithmetic average and standard deviation of sleep in the last measurement, in contrast to the first measurement M=13.2, ±0.43). Taking into account that the patient groups had equally severe clinical insomnia first day of hospitalization, significant improve shows a group of patients who received hypnotic therapy with primary disease. This result clearly shows the difference in jumping score in both groups (Figure 1, 2). In the first group with two drugs, there was a jump of 16 (average) to 4, while the second group with a single drug-jump score decreased from 10 to 5.
CONCLUSIONS:
Treatment of insomnia in schizophrenic patients, underlying disease, as well as extending treatment with hypnotics is very effective. Treatment of hypnotics, in accordance with the hypothesis of this study, gives better results. Clinical features of insomnia significantly improves after the application of this treatment modality. |
