Στην Σουηδία απαγορεύαν και απαγορεύουν σχεδόν δια ροπάλου την χρήση αντιψυχωσικών φαρμάκων σε ασθενείς που δεν είχαν ποτέ ψύχωση.
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Όταν ήρθα όμως στην Ελλάδα είδα πολλούς ασθενείς με απλές καταθλίψεις να λαμβάνουν αγωγή με αντιψυχωσικά (κατά προτίμηση της τελευταίας γενιάς που είναι και πανάκριβα) με ότι μπορεί να συνεπάγεται αυτό σε παρενέργειες για τους ασθενείς αλλά και σε οικονομικό κόστος για την κοινωνία.
Από ότι φαίνεται όμως από τον σχολιασμό ενός σχετικού επιστημονικού άρθρου του BMJ από το Journal Watch, σχολιασμό τον οποίο παραθέτω παρακάτω, ανάλογες καταστάσεις παρατηρούνται και στην Αγγλία.
Να υποθέσω ότι οι Φαρμακευτικοί αντιπρόσωποι κάνουν καλά την δουλειά τους;December 31, 2014Large Proportions of Patients Who Are Prescribed Antipsychotics in the U.K. Do Not Have Severe Mental IllnessesPaul S. Mueller, MD, MPH, FACP reviewing Marston L et al. BMJ Open 2014 Dec 18.Instead, antipsychotics were prescribed for conditions such as anxiety, sleep disorders, and dementia.
Antipsychotic drugs are used to treat patients with severe mental illnesses, such as schizophrenia, other psychoses, and bipolar affective disorder. However, evidence suggests that these drugs are prescribed frequently for patients with anxiety, dementia, and sleep disorders. In this study, U.K. investigators used a primary care database to determine the indications for which antipsychotics were prescribed in 48,000 patients.
Fourteen thousand patients were prescribed first-generation antipsychotics (haloperidol, chlorpromazine, trifluoperazine), 28,000 were prescribed second-generation antipsychotics (olanzapine, quetiapine, risperidone), and 6,000 received prescriptions for both classes of drugs. Antipsychotic prescribing rates were higher in women than in men, in older adults (age, 80 vs. 40–49), and in people from the most-deprived versus the least-deprived areas.
Of patients who were prescribed first-generation antipsychotics, only about 30% had severe mental illnesses; of those who were prescribed second-generation antipsychotics, 36% to 62% had severe mental illnesses. Common indications for antipsychotic prescribing in patients without severe mental illnesses were anxiety, depression, dementia, sleep disorders, and personality disorders; in these patients, antipsychotics generally were prescribed at lower doses and for shorter durations.
Comment
In this study, large proportions of U.K. primary care patients who were prescribed antipsychotic drugs did not have schizophrenia, other psychoses, or bipolar affective disorder — the usual indications for these drugs. Instead, these drugs were prescribed for nonpsychotic and nonbipolar illnesses such as anxiety, dementia, and sleep disorders, albeit at lower doses and for shorter durations.
Although “off-label” use of antipsychotics can relieve symptoms in carefully selected patients, clinicians should be aware of the adverse effects of these drugs, including elevated risk for stroke and higher mortality in patients with dementia (NEJM JW Gen Med Sep 11 2008; NEJM JW Gen Med Oct 11 2007).
Citation(s):
Marston L et al.
Prescribing of antipsychotics in UK primary care: A cohort study. BMJ Open 2014 Dec 18; 4:e006135. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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Θέμα: Αντιψυχωσικά σε μη ψυχωτικούς ασθενείς; (Αναγνώστηκε 49867 φορές)
29 Μαρτίου 2009, 18:51:33