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  1. PHARMACOEPIDEMIOLOGICAL MONITORING HELPS IN REDUCING OF NEUROLEPTIC-INDUCED EXTRAPYRAMIDAL DISORDERS AT THE PSYCHIATRIC CLINICAL HOSPITAL OF THE REPUBLIC OF TATARSTANZiganshina LE, Kuchaeva AV, Gatin FF, Minnetdinova LMKazan State Medical Academy and Republican Clinical Psychiatric Hospital — Russia

  2. Pharmacoepidemiological Monitoring Helps in Reducing Neuroleptic-Induced Extrapyramidal Disorders at the Psychiatric Clinical Hospital in TatarstanZiganshina LE, Kuchaeva AV, Gatin FF, Minnetdinova LMKazan State Medical Academy and Republican Clinical Psychiatric Hospital, RussiaProblem Statement:Extrapyramidal movement disorders caused by neuroleptics are easily diagnosed; however, the prognosis of their development and the severity of presentation remains obscure. Polypharmacy and drug interactions contribute to the complexity of the problem.Objectives: To evaluate the effect of pharmacoepidemiological monitoring of the use of neuroleptics on prescription habits of psychiatrists using the World Health Organization (WHO) drug use indicators.Design: Drug use indicator study.Setting and Population:Special sheets for registering the side effects of neuroleptics were developed and included in regular medical charts in 2000–2002. The case records of 666 patients with schizophrenia in whom extrapyramidal reactions were registered were randomly chosen for statistical analysis. Total daily doses of neuroleptics were calculated with the help of chlorpromazine equivalent, and ATC classification was used for analysis.Intervention: The initial drug use indicator study was carried out in 2001. The dosage of neuroleptics and monitoring of drug safety and interactions were implemented for the two-year period (2001–2002). The subsequent drug use study was performed in 2002.OutcomeMeasures: Total daily doses of neuroleptics (in terms of oral chlorpromazine and defined daily doses), the WHO drug use indicators.Results:The total daily dose of neuroleptics in patients with paranoid schizophrenia with hallucinative-paranoidal syndrome in 2000 was 3,053 ±116 mg of oral chlorpromazine. In cases of paranoid schizophrenia with prevalent paranoid syndrome, the total neuroleptic load was lower at 2,547 ±107 mg. In patients with a history of cerebral-organic deficiency, the total neuroleptic load was 1,653 ±123 mg. The number of medicines prescribed per case (indicator 1) was 8.3 ±0.5 in 2001. After introduction of the active monitoring system, it decreased to 5.8 ±0.6 medicines per case in 2002. The percentage of generic medicines prescribed (indicator 2) was 56.7% in 2001 and 69.1% in 2002. The percentage of cases with antibiotics prescribed (indicator 3) was 32.2% in 2001 and 10.6% in 2002. The frequency of injection use (indicator 4) was 40.8% in 2001 and 38.8% in 2002. The percentage of medicines prescribed from the formulary list (indicator 5) was only 63.5% in 2001 but had risen to 99% in 2002.Conclusions: The introduction of a pharmacoepidemiological monitoring system in a psychiatric clinical hospital proved effective in reducing polypharmacy, injection and antibiotic use, and the total neuroleptic load and adverse effects profile in schizophrenia patients.

  3. Background/IntroductionPsychotropic medicines allow to control the symptoms of schizophrenia. The prognosis of schizophrenia depends on the adequate and timely anti-psychotic therapy which is necessary for prevention of irreversible personality changes of the patients. One of the major problems of psychopharmacotherapy of schizophrenic patients is the problem of side-effects.

  4. Objectives: • To evaluate the effect of pharmacoepidemiological monitoring • on the use of neuroleptics • on prescription habits of psychiatrists using the World Health Organization (WHO) drug use indicators.

  5. Methods • Clinical Psychiatric Hospital of the Ministry of Health of the Republic of Tatarstan (>2000 beds) • 7475 side effects registration cards - 2000, 2001, 2002 • Chlorpromazine equivalents for calculation of the total neuroleptics’ daily doses • ATC-DDD methodology. • Subgroup analysis: age, gender, length of neuroleptic treatment and various forms of paranoid schizophrenia. • Drug use indicator (DUI) methodology: random sample of the DUI registration cards (each even medical chart of each month) – 745 records for 2001 and 1281 records for 2002.

  6. Movement disorders in schizophrenic patients in the years 200-2002 and total daily neuroleptic doses *n - number of patients with movement disorders, **N – total number of patients

  7. Prescribed daily doses of neuroleptics (in DDDs) in patients – men and women, causing movement disorders (2000-2002). * – p<0,05 difference between women and men.

  8. Comparison of the number of cases of extrapyramdal movement disorders in women and men with various forms of schizophrenia (2000-2002). • *-р < 0,05 - level of statistical significance of distinctions between women and men.

  9. The Drug Use Indicators in the Republican Clinical Psychiatric Hospital of the Republic of Tatarstan (2001, 2002).

  10. Discussion • The neuroleptics are needlessly overused in treatment of paranoid schizophrenia. • Drug use monitoring was an effective measure to improve the prescribing habits of psychiatrists. • Despite of achieved results the so called preventive use of anticholinergics as well as polypharmacy in antipsychotics’ prescription persisted. • This proves the necessity of introduction of educational interventions for psychiatrists and the importance of further drug use monitoring in this field.

  11. Conclusions:The introduction of a pharmacoepidemiological monitoring system in a psychiatric clinical hospital proved effective in reducing polypharmacy, injection and antibiotic use, and the total neuroleptic load and adverse effects profile in schizophrenia patients.

  12. Conclusion - 2 • Strength • Drug use and side effects monitoring methodology for improvement of pharmacotherapy of schizophrenic patients - Drug use indicators’ registration cards and side effects’ registration cards in regular medical charts • Weaknesses • Lack of educational intervention • What to do next • Monitor drug use and side effects and educate on regular basis

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