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- Title
Eğitim Kurumlari Dışinda Görevli Bir Grup Psikiyatristin Antipsikotik Seçme, Kombine Etme ve Doz Ayarlama Örüntüleri.
- Authors
Karamustafalıoğlu, Oğuz; Özçelik, Bağak; Gönenli, Sinem; Bakım, Bahadır; Cengiz, Yasemin
- Abstract
Objective: Clinical research and powerful meta-analyses show incongruent findings about efficacy and side effects of antipsycotics. Results of studies focusing on how to choose an antipsychotic drug, dosing, combining those drugs optimally, and factors impacting the psychiatrists' decisions in clinical practice seem insufficent to draw firm conclusions. The aim of this study was to clarify the prescription patterns of antipsychotics among a group of psychiatrists working at nonteaching state hospitals. Methods: This was a cross-sectional questionnaire survey which was conducted by the psychiatry unit of Sisli Etfal Research and Teaching Hospital between December 2004 and February 2005. Questionnaires were mailed to 246 full-time or part-time psychiatrists working at non-teaching state hospitals, which were affiliated with The Ministry of Health, at the time of the study. The sample of the study consisted of 75 psychiatrists who mailed back the completed questionnaires by February 2005. The questionnaire included items about sociodemographic variables, choosing antipsychotics, dosing, combinations, side effects, pharmacokinetics, and pharmacodynamics of those drugs. Only, the antipsychotics which were in the market during the study period, were surveyed (excluded ziprasidone, sertindole, and aripiprazole). Results: When psychiatrists were asked about the first three indications to start an antipsychotic treatment, majority of them (93%) stated psychotic disorders, more than half (67%) bipolar disorder, half of them (50%) psychotic depression, and finally 13% reported obsessive-compulsive disorder. A total of 56 psychiatrists (75%) preferred atypical antipsychotics as the firstline agent when treating schizophrenia and other psychotic disorders. Approximately, 25% of the sample (n=19) expressed depot antipsychotics as "often/almost always prescribed agents". Similarly, 21% of the sample reported they "often/almost always" combined two or more antipsychotics. The most commonly prescribed combination was haloperidol and chlorpromazine. For the treatment of the acute episode of schizophrenia, the mean doses of antipsychotics reported by the psychiatrists were dispersed in the usual dose ranges (near to the highest doses) approved by FDA. The mean antipsychotic doses for the treatment of schizophrenia and bipolar disorder (for both acute and maintenance phases) were similar. In the questionnaires, side effects of antipsychotics seemed different between typicals and atypicals; tardive dyskinesia, extrapyramidal syndrome, rhythm disorders were reported more frequently with typical antipsychotics, whereas weight gain and diabetes mellitus were seen more with atypicals. For some antipsychotics like sulpride, amisulpride, risperidone, and quetiapine, as the age of the psychiatrist, years as a physician, and the number of patients/day evaluated at the hospital increased, doses of antipsychotics decreased according to reports by the sample. On the other hand, for olanzapine and clozapine, a positive correlation was found between above mentioned variables and antipsychotic doses. This findings could not be generalized for all the acute and maintenance phases of disorders. Conclusion: This study might shed some light to the clinical practice with regard to antipsyhotic selection, conbination, and dosing among a group of experienced psychiatrists working at non-teaching state hospitals throughout Turkey. The results might show some differences between clinical practice and research data regarding antipsychotics.
- Subjects
TURKEY; PSYCHIATRISTS; SIDE effects of antipsychotic drugs; STATE hospitals; OLANZAPINE; CLOZAPINE
- Publication
Klinik Psikofarmakoloji Bulteni, 2009, Vol 19, Issue 3, p263
- ISSN
1017-7833
- Publication type
Article