Katatona šizofrēnija: klīniskais raksturojums un terapeitiska pieeja stacionāra pacientiem.
No Thumbnail Available
Date
2022
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads. Līdz ar neiroleptisko līdzekļu ieviešanu katatona šizofrēnija ir gandrīz izzudusi no pētnieku redzesloka un pastāv tās ievērojama hipodiagnostika. Lai gan katatonijas jēdziens ir piedzīvojis ievērojamu atgriešanos divdesmitā gadsimta beigās, sarežģītākā katatonas šizofrēnijas problēma piesaista daudz mazāku uzmanību, kā arī tā ātri izzūd no psihiatriskās klasifikācijas.
Aktualitāte. Katatona šizofrēnija ir reta šizofrēnijas forma un mūsdienīgas farmakoterapijas iespēju dēļ, tās klīniskā aina var būt notušēta vai modificēta, savukārt terapeitiskās pieejas ir komplicētas.
Darba mērķis. Novērtēt katatonas šizofrēnijas klīnisko raksturojumu, predisponējošos faktorus un farmakoloģisko terapeitisko pieeju VSIA Rīgas Psihiatrijas un Narkoloģijas Centra (RPNC) stacionāra pacientiem.
Materiāli un metodes. Pētījums ir šķērsgriezuma retrospektīvs. Tika analizētas VSIA RPNC pacientu slimības vēstures ar katatonas šizofrēnija diagnozi (F20.2 pēc SSK-10). Tika atlasīti pacienti vecumā no 18 līdz 65 gadiem, kas saņēma ārstēšanu stacionārā laika posmā no 2012. līdz 2021. gadam. Teorētiskajā daļā tika analizēti vairāki zinātniskie raksti, publikācijas, starptautiskās vadlīnijas. Iegūto datu analīzei un apkopošanai tika izmantotas: kvantitatīvā metode, izmantojot slimības vēstures novērtēšanas protokolu, kas sastāv no četru jautājumu grupām; statistiskā metode, izmantojot MS Excel un IBM SPSS Statistics 27 programmas.
Rezultāti. Lielākais pacientu skaits ir vīriešu dzimuma (66%), 26-35 gadu vecumā (29%). Katatonijas stuporoza simptomātika ir vairāk raksturīga slimības sākumā, pirmajās paasinājumu epizodēs (79,2%), bet slimības gaitā atkārtotu paasinājumu epizodēs prevalēja motoriskā uzbudinājuma aina (70,6%). No šizofrēnijas pamata simptomiem raksturīgākais ir halucinatorās balsis (līdz 52,9%), no papildus simptomiem sākumā vairāk raksturīgi primāri negatīvie simptomi (58%), bet turpmāk uzvedības traucējumi ar pasivitāti, bezdarbību u.c. (52,9%). Somatiskās blakusslimības ir konstatētas 16,6% gadījumu, pašnāvības domas un mēģinājumi 8,5%. Visbiežāk tika pielietoti tipiskie antipsihotiskie (87,5%), atipiskie antipsihotiskie (88,2%) un antiholīnerģiskie (94,1%) līdzekļi. Benzodiazepīnu grupas medikamenti tika pielietoti 62,5% gadījumu. Starp riska faktoriem pacientiem ar katatonu šizofrēniju bija dopamīna blokatoru lietošana (58,3%), ilgstoša antiholīnerģisku medikamentu lietošana (50%), paaugstināts psihoemocionālā stresa līmenis (37,5%), nelabvēlīga pārmantotība (33,3%), pēkšņa klozapīna lietošanas pārtraukšana (29,2%) un zems sociālekonomiskais stāvoklis (25%).
Secinājumi. Katatonas šizofrēnijas terapijas rekomendācijas uz pierādījumiem balstītās vadošās starptautiskās vadlīnijas un Latvijas vadlīnijās netika atrastas. Gandrīz visiem pacientiem tika nozīmēti tipiskie un atipiskie antipsihotiskie, kā arī antiholinerģiskie līdzekļi – gan pirmā apskatītā akūtā paasinājuma brīdi, gan pēdējā, kas neatbilst klīniskām rekomendācijām. Slimības pirmreizēja paasi
Introduction. With the introduction of neuroleptics, catatonic schizophrenia has almost disappeared from the eyes of researchers and is undergoing a significant hypodiagnostics. Although the concept of catatonia has undergone a significant return in the late 20th century, the more complex problem of catatonic schizophrenia attracts much less attention and is rapidly disappearing from the psychiatric classification. Relevance. Catatonic schizophrenia is a rare form of schizophrenia and due to the potential of modern pharmacotherapy, its clinical picture may be obscured or modified, while therapeutic approaches are complicated. The aim of the work. The aim is to evaluate the clinical characteristics of catatonic schizophrenia, predisposing factors and pharmacological therapeutic approach in inpatients of VSIA Riga Psychiatry and Narcology Center (RPNC). Materials and methods. The study is a cross-sectional retrospective. Medical records of hospitalization of VSIA RPNC patients diagnosed with catatonic schizophrenia (F20.2 due to ICD-10) were analyzed. Patients aged 18 to 65 years who received inpatient treatment from 2012 to 2021 were selected. In the theoretical part, several scientific articles, publications, international guidelines were analyzed. The following methods were used to analyze and summarize the data obtained: a quantitative method using a medical history assessment protocol consisting of 4 groups of questions; statistical method using MS Excel and IBM SPSS Statistics 27 programs. Results. The largest number of patients is male (66%), aged 26-35 years (29%). The symptoms of catatonic stuporosis are more common at the onset of the disease in the first episodes of exacerbation (79.2%), but the recurrence of exacerbations during the course of the disease was dominated by motor agitation (70.6%). The most common of the main symptoms of schizophrenia are hallucinatory voices (up to 52.9%), of the additional symptoms – primary negative symptoms are more common at first (58%), but later behavioral disorders with passivity, inactivity, etc. (52.9%). Somatic co-morbidities have been reported in 16.6% of cases, suicidal thoughts and attempts in 8.5%. Typical antipsychotics (87.5%), atypical antipsychotics (88.2%) and anticholinergics (94.1%) were used most frequently. Benzodiazepines were used in 62.5% of cases. Risk factors in patients with catatonic schizophrenia included the use of dopamine blockers (58.3%), long-term use of anticholinergic drugs (50%), increased levels of psycho-emotional stress (37.5%), adverse heredity (33.3%), abrupt discontinuation of Clozapin (29.2%) and low socio-economic status (25%). Conclusions. Recommendations for the treatment of catatonic schizophrenia are not found in the evidence-based leading international guidelines and in the Latvian guidelines. Almost all patients were prescribed typical and atypical antipsychotics as well as anticholinergics, both at the time of the first and the last acute exacerbation,
Introduction. With the introduction of neuroleptics, catatonic schizophrenia has almost disappeared from the eyes of researchers and is undergoing a significant hypodiagnostics. Although the concept of catatonia has undergone a significant return in the late 20th century, the more complex problem of catatonic schizophrenia attracts much less attention and is rapidly disappearing from the psychiatric classification. Relevance. Catatonic schizophrenia is a rare form of schizophrenia and due to the potential of modern pharmacotherapy, its clinical picture may be obscured or modified, while therapeutic approaches are complicated. The aim of the work. The aim is to evaluate the clinical characteristics of catatonic schizophrenia, predisposing factors and pharmacological therapeutic approach in inpatients of VSIA Riga Psychiatry and Narcology Center (RPNC). Materials and methods. The study is a cross-sectional retrospective. Medical records of hospitalization of VSIA RPNC patients diagnosed with catatonic schizophrenia (F20.2 due to ICD-10) were analyzed. Patients aged 18 to 65 years who received inpatient treatment from 2012 to 2021 were selected. In the theoretical part, several scientific articles, publications, international guidelines were analyzed. The following methods were used to analyze and summarize the data obtained: a quantitative method using a medical history assessment protocol consisting of 4 groups of questions; statistical method using MS Excel and IBM SPSS Statistics 27 programs. Results. The largest number of patients is male (66%), aged 26-35 years (29%). The symptoms of catatonic stuporosis are more common at the onset of the disease in the first episodes of exacerbation (79.2%), but the recurrence of exacerbations during the course of the disease was dominated by motor agitation (70.6%). The most common of the main symptoms of schizophrenia are hallucinatory voices (up to 52.9%), of the additional symptoms – primary negative symptoms are more common at first (58%), but later behavioral disorders with passivity, inactivity, etc. (52.9%). Somatic co-morbidities have been reported in 16.6% of cases, suicidal thoughts and attempts in 8.5%. Typical antipsychotics (87.5%), atypical antipsychotics (88.2%) and anticholinergics (94.1%) were used most frequently. Benzodiazepines were used in 62.5% of cases. Risk factors in patients with catatonic schizophrenia included the use of dopamine blockers (58.3%), long-term use of anticholinergic drugs (50%), increased levels of psycho-emotional stress (37.5%), adverse heredity (33.3%), abrupt discontinuation of Clozapin (29.2%) and low socio-economic status (25%). Conclusions. Recommendations for the treatment of catatonic schizophrenia are not found in the evidence-based leading international guidelines and in the Latvian guidelines. Almost all patients were prescribed typical and atypical antipsychotics as well as anticholinergics, both at the time of the first and the last acute exacerbation,
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Katatona šizofrēnija, Katatonija, Klīniskais raksturojums, Terapeitiska pieeja, Predisponējošie faktori, Catatonic schizophrenia, Catatonia, Clinical characteristics, Therapeutic approach, Predisposing factors