TITOLO TESTO

Transcript

1

2 TITOLO TESTO

3

4 TITOLO TESTO

5 TITOLO TESTO

6 NIH web site Nichols-English g. et al J. Am. Pharm. Assoc. 2000;40(4) NCPIIE the other drug proble 1997 Mancata aderenza ai Trattamenti Include: Non assumere la dose prescritta Assumere dose diversa da quella prescritta Assumere dose giusta al tempo sbagliato Dimenticare dosi Interrompere il trattamento troppo presto

7

8 Factors influencing adherence Velligan et al, J Clin Psychiatry 2009 Poor insight into having an illness Distress associated with persistent side effects Lack of/partial efficacy with continued symptoms Believing that medications are no longer needed Ongoing substance use problems Cognitive deficits Lack of social support to help with medication-taking Practical problems (transportation, financial) Problems with therapeutic alliance Lack of daily routines Complexity of treatment regimen Significant others ambivalent/opposed to treatment Stigma associated with mental illness and medication Negative attitudes toward medications in general

9 Amador XF, Flaum M, Andreasen NC, et al. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry 1994; 51: Il 57% dei pazienti ha una mancanza di insight valutabile tra moderata e severa, circa la consapevolezza di avere una malattia grave. Il 32% erano inconsapevoli delle conseguenze sociali della loro malattia Il 22% negava ogni forma di effetto benefico dai trattamenti farmacologici

10 Schizofrenia: nuove prospettive del trattamento farmacologico con antipsicotici long acting Minore incidenza di EPS e maggiore compliance Ampio margine tera peutico e basso potenziale di interazioni farmacocinetiche Efficacia nelle forme resistenti e sui sintomi negativi Nuovi spazi per interventi riabilitativi

11 J Manag Care Spec Pharm Sep;21(9): Antipsychotic Adherence and Rehospitalization in Schizophrenia Patients Receiving Oral Versus Long-Acting Injectable Antipsychotics Following Hospital Discharge. Marcus SC1, Zummo J, Pettit AR, Stoddard J, Doshi JA.

12 Patients initiated on LAI medications, particularly SGA LAIs, showed lower odds of all 3 key outcomes: nonadherence (as measured by PDC), discontinuation (defined as a 60-day continuous gap in available medication), and schizophrenia-related rehospitalization in the 6 months following an index hospitalization for schizophrenia, compared with patients receiving oral medications. J Manag Care Spec Pharm Sep;21(9):

13 TITOLO TESTO

14 INSIGHT TREATMENT ADHERENCE McEvoy et al., 1989; David et al., 1992; Perkins, 2002 PSYCHOSOCIAL FUNCTIONING Dickerson et al., 1997; Amador et al., 1994 UTILIZATION OF EMERGENCY SERVICES Haro et al., 2001 PROGNOSIS Schwartz et al., 1997 INVOLUNTARY HOSPITALIZATIONS Kelly et al., 2004 VIOLENT BEHAVIOR Buckley et al., 2004

15 Insight e aderenza Il WHO International Pilot Study on Schizophrenia ha dimostrato come la mancanza di insight fosse presente nel 98% dei pazienti. Jablensky A, Sartorius N, Ernberg G, et al. Schizophrenia: manifestations, incidence, and course in different cultures: a World Health Organization 10-country study. Psychol Med Monogr Suppl 1992; 20: 1-97

16 Patients who have tried both an oral and a long-acting formulation of an antipsychotic often prefer the long-acting form. This was demonstrated in 5 studies conducted in Europe, which showed that at least half the patient populations surveyed preferred conventional depot antipsychotics to the oral formulation. Reasons for this preference included convenience, feeling of control over treatment, and that the injection was easier than taking daily medications. The single study (Desai 1999) in which patients preferred an oral to a conventional depot compared a conventional depot with an oral atypical. Walburn J et al. Br J Psychiatry. 2001;179:

17

18

19 TITOLO TESTO

20 TITOLO TESTO

21 Grazie per l attenzione