| Abstract | CILJ ISTRAŽIVANJA:
Ispitati utjecaj terapije dugodjelujućim i peroralnim risperidonom na rehospitalizaciju
shizofrenih bolesnika. Terapija dugodjelujućim risperidonom dovodi do manjeg broja
rehospitalizacija, odnosno recidiva u odnosu na peroralnu terapiju.
USTROJ ISTRAŽIVANJA:
Provedena je prospektivna studija u trajanju od 34 tjedna. Glavni uključujući kriteriji su
dijagnoza shizofrenije prema MKB-10, pacijenti oba spola stariji od 18 godina, BPRS pri
ulasku najmanje 30 i CGI-S najmanje 3. Bolesnike smo podijelili u dvije skupine, jedna je
primala peroralnu terapiju, a druga terapiju dugodjelujućim risperidonom. Nakon
provedenog liječenja smo najprije nakon 4 tjedna, zatim svakih 6 tjedana procjenjivali broj
rehospitaliziranih bolesnika na jednoj i drugoj terapiji.
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 siječnja 2011. do rujna 2011. godine
indicirana primjena antipsihotika risperidona u peroralnom ili dugodjelujućem obliku.
GLAVNE MJERE ISHODA:
Pratili smo ukupno 40 bolesnika koji su uzimali peroralnu terapiju risperidonom. Nakon
4 tjedna polovici broja bolesnika uvodimo dugodjelujući risperidon. Dozu lijeka smo titrirali
ovisno o težini kliničke slike koju smo procjenili pomoću BPRS ljestvice. Svakih 6 tjedana smo
razmatrali broj rehospitalizacija odnosno recidiva bolesti i procjenu poboljšanja bolesti
pomoću CGI-I ljestvice. Procjene smo radili svakih 6 tjedana, ukupno 34 tjedna i na kraju smo
usporedili broj rehospitaliziranih pacijenata na peroralnoj s brojem na dugodjelujućoj
terapiji. Početna korištena doza za peroralni risperidon je 2mg, a povećavala se ovisno o težini kliničke slike na 4, 6 ili 12 mg, dok smo za dugodjelujući koristili doze od 25, 37, 5 i 50
mg.
REZULTATI:
Od 40 shizofrenih bolesnika medijana životne dobi 34,6 god (min-max:19-53) njih 20
liječeno je dugodjelujućim, a 20 peroralnim antipsihotikom risperidonom. Nakon provedene
terapije peroralnim i dugodjelujućim risperidonom u skupini bolesnika s dugodjelujućom
terapijom je 2,8 puta više bolesnika koji nisu rehospitalizirani nego u skupini peroralne ( 74%
[17/20] vs. 26% [6/20], χ2=12,3; p<0,001). 11 ispitanika (55%) na terapiji dugodjelujućim
risperidonom je pokazalo izuzetno poboljšanje na CGI-I ljestvici. Kod bolesnika na
dugodjelujućoj terapiji je zabilježeno poboljšanje u kliničkoj slici, BPRS na početku 51 (38-65)
do 24,5 (19-35) na kraju, vrijednost medijana je za 10,5 niža (z=2,6; p<0,001). Nismo dokazali
povezanost rehospitalizacije sa spolom (χ2 =0,06; p=0,084), s bračnim statusom (χ2=1,01;
p=0,314), radnim statusom ( χ2= 0,17; p=0,679) i s dobi bolesnika (z=1,17; p=0,242).
ZAKLJUČCI:
Rehospitalizacija bolesnika koji su bili na terapiji dugodjelujućim risperidonom je
značajno manja u odnosu na bolesnike koji su liječeni peroralnom terapijom.
Dugodjelujući risperidon je u korelaciji s boljim odgovorom na terapiju, većim poboljšanjem
kliničkih simptoma te većem smanjenju (redukciji) dana provedenih u bolnici. |
| Abstract (english) | OBJECTIVE:
To examine the effect of long-acting and oral risperidon on rehospitalization in
schizophrenic patients. Long- acting risperidone leads to fewer rehospitalization and relapse
in relation to oral therapy.
DESIGN:
We conducted a prospective study lasting 34 weeks. The main criteria for including the
diagnosis of schizophrenia according to ICD-10, patients of both sexes older than 18 years,
BPRS entering at least 30 and CGI-S at least 3. Patients were divided into two groups, one
receiving oral therapy and other long-acting risperidone therapy. After the treatment, we
first assessed after 4 weeks relapse and then every 6 weeks.
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 January 2011 until
September 2011 who were indicated use of antipsychotic risperidone in oral or long-acting
form.
MAIN OUTCOME MEASURES:
We followed 40 patients who were taking oral risperidone therapy. After 4 weeks, half
the number of patients we introduced long-acting risperidone. Doses are titrated depending
on the severity of the clinical symptoms, which we estimate using the BPRS scale. Every 6
weeks we looked at the number of rehospitalization or recurrent disease and assessment of
disease improvement using the CGI-I scale. Assessments are done every 6 weeks, a total of 34 weeks and in the end we compared the number of patients with oral rehospitalizations
with the number of rehospitalizations on long- acting therapy. Starting doses used for oral
risperidone was 2 mg, and increased depending on the severity of the clinical picture in 4, 6
or 12 mg, whereas we used long-acting doses of 25, 37, 5 and 50 mg.
RESULTS:
Of 40 schizophrenic patients, median age 34.6 yr (min-max :19-53) 20 of them were
treated with long-acting, and 20 oral antipsychotic risperidone. After the treatment with oral
and long-acting risperidone in patients with long-acting therapy is 2.8 times more patients
who are not rehospitalized than in the oral group (74% [17/20] vs. 26% [6/20], χ2 = 12.3 p
<0.001). 11 respondents (55%) treated with long-acting risperidone has demonstrated
exceptional improvement on the CGI-I scale. In patients on long- acting therapy greater
improvement was noted in the clinical symptoms. BPRS at the beginning of 51 (38-65) to
24.5 (19-35) at the end of treatment. The median value was lower by 10.5 (z = 2.6, p <0.001).
We have not shown association in rehospitalization with sex (χ2 = 0.06, p = 0.084), with
marital status (χ2 = 1.01, p = 0.314), employment status (p = 0.679) and patient age (z = 1.17;
p = 0.242).
CONCLUSIONS:
Rehospitalization in patients who were treated with long-acting risperidone was
significantly lower than patients who were treated with oral therapy.
Long-acting risperidone is correlated with better response to treatment, greater
improvement in clinical symptoms and a greater reduction (reduction) of days spent in
hospital. |
