preparat “ketileptis” (Quetiapine) klinikuri efeqturobis Sefaseba Sizofreniis, Sizoafeqturi, bodviTi da afeqturi aSlilobis mkurnalobaSi.
g. sixaruliZe, g. naneiSvili, n. okribelaSvili, v.kenWaZe
fsiqikuri janmrTelobis centri “mentalvita”
kvlevis mizani
kvlevis mizani iyo samkurnalwamlo saSualebis “ketileptis” (Quetiapine) efeqturobis gansazRvra iseTi speqtris fsiqikuri aSlilobebis dros, rogoricaa: Sizofrenia, Sizoafeqturi, bodviTi da afeqturi aSlilobani.
kvlevis dizani
kvleva ganxorcielda fsiqikuri janmrTelobis centr “mentalvitaSi” 24 stacionirebul pacientze. aRniSnul kvlevaSi CarTuli iyvnen pacientebi daavadebaTa saerTaSoriso klasifikaciis (ICD-10) Semdegi nozologiuri jgufebidan: afeqturi aSlilobani F30-F39, Sizofrenia, Sizotipuri aSlilobani F20- F29, organuli bunebis aSlilobani, F06-F07, nevrozuli, stresTan dakavSirebuli da somatoformuli aSlilobani F40-F4.
daavadeba verificirebuli iyo dsk-10-is kriteriumebis Sesabamisad. kvlevaSi CarTuli pacientebi, aseve, akmayofilebdnen Semdeg kriteriumebs: asaki – 18 - 65 weli; fsiqozis gamo araumetes 5 stacionireba.
agreTve kvlevaSi CarTul iyvnen fsiqikuri janmrTelobis centr “mentalvita”-Si momuSave fsiqiatrebTan ambulatoriul mkurnalobaze myofi pacientebi. sul 39 pacienti. aRniSnuli jgufis kvlevaSi CarTvis kriteriumebi iyo igive rac stacionarul mkurnalobaze myof pacientebSi.
preparat ketileptis dozireba ganisazRvreboda 25 mg/dR, - 1000 mg/dR. kvlevis xangrZlivoba stacionarul mkurnalobaze myof pacientebSi ganisazRvreboda 5-dan 15 dRemde, xolo ambulatoriul mkurnalobaze myof pacientebSi 15-dan 45 dRemde.
pacientis fsiqikur statusze preparat “ketileptis” efeqturoba ganisazRvreboda rogorc eqimis mier subieqturad aseve saerTaSoriso praqtikaSi aprobirebuli kiTxvarebiT: pozitiuri simptomebis Sefasebis skala (SAPS); negatiuri simptomebis Sefasebis skala (SANS); bekis depresiis skala (BDI II)
kvlevaSi CarTul pacientebSi xdeboda Semdegi gverdiTi efeqtebis kontroli da aRnusxva: arteriuli wneva, insomnia, eqstrapiramiduli movlenebi, Tavis tkivili, Zilianoba, Tavbrusxveva, hiperaqtivoba, SfoTva.
miRebuli Sedegebi
stacionarul mkurnalobaze myofi pacientebis raodenobam, romlebic CarTuli iyvnen ketileptis kvlevaSi Seadgina 24.
ambulatoriul mkurnalobaze myofi pacientebis raodenobam, romlebic CarTul iyvnen aRniSnuli preparatis kvlevaSi Seadgina 39,
stacionarul mkurnalobaze myof pacientebSi preparatis dozireba Seadgenda 25 – 1000 mg-s.
ambulatoriul mkurnalobaze myof pacientebSi preparatis dozireba umetes SemTxvevebSi Seadgenda 50- 600 mg-s.
fsiqozuri registris aSlilobebis dros pozitiuri simtomebis reducirebis xarisxi ganisazvra kvlevis dawyebamde da kvlevis damTavrebis Semdeg Catarebuli zemoT aRniSnuli skalebis saSualebiT.
qvemoT moyvanil cxrilebSi warmodgenilia pozitiuri da negatiuri simptomebis gradualuri kleba kvlevis periodSi:
cxrili # 1 –
pozitiuri simptomebis Sefasebis kiTxvari stacionari – “ketilepti” (Quetiapine)
SAPS | preparatis miRebamde | kvlevis dasrulebisas |
qulebi | 48 | 18 |
cxrili # 2 –
negatiuri simptomebis Sefasebis kiTxvari stacionari – “ketilepti” (Quetiapine)
SANS | preparatis miRebamde | kvlevis dasrulebisas |
qulebi | 38 | 28 |
cxrili # 3 –
pozitiuri simptomebis Sefasebis kiTxvari ambulatoria – “ketilepti” (Quetiapine)
SAPS | preparatis miRebamde | kvlevis dasrulebisas |
qulebi | 32 | 11 |
cxrili # 4–
negatiuri simptomebis Sefasebis kiTxvari ambulatoria – “ketilepti” (Quetiapine)
SANS | preparatis miRebamde | kvlevis dasrulebisas |
qulebi | 33 | 20 |
cxrili # 5 –
depresiis Sefasebis kiTxvari stacionari – “ketilepti” (Quetiapine)
BECK | preparatis miRebamde | kvlevis dasrulebisas |
qulebi | 21 | 11 |
cxrili # 6 –
depresiis Sefasebis kiTxvari ambulatoria – “ketilepti” (Quetiapine)
BECK | preparatis miRebamde | kvlevis dasrulebisas |
qulebi | 24 | 8 |
arasasurveli Tanamovlenebi “ketilepti” (Quetiapine) gamoyenebisas gamovlinda Semdegi sixSiriT
cxrili # 3 -
ketilepti - arasasurveli Tanamovlenebi
arasasurveli Tanamovlenebidan yvelaze maRali sixSiriT gamovlinda Zilianoba (11.1%), Semdeg SfoTva (7.4%), hiperaqtiuroba (3.7%), Tavis tkivili (3.7%).
eqstrapiramiduli garTulebebi praqtikulad ar gamovlenila, Tu gaviTvaliswinebT imas, rom preparatis SedarebiT maRali dozebiT gamoyenebisas (200-800 mg/dR) pacients damatebiT eZleoda koreqtori. Zilianoba ar warmoadgenda xSir garTulebas da aRniSnuli arasasurveli gverdiTi efeqtis kupireba moxda efeqturi dozis SerCevidan ramodenime dReSi.
hiperaqtiurobis gamovlenis sixSire Cvens SemTxvevaSi Seadgenda 3.7 % -s (4 pacienti), rac, SesaZloa, ganpirobebuli iyos preparat ketileptis nawilobriv mastimulirebeli moqmedebiT. savaraudod, preparat ketileptis mastimulirebeli efeqti ganapirobebs negatiur simptomebze dadebiT moqmedebas, preparatis xangrZlivi miRebis SemTxvevaSi.
kvlevaSi CarTuli pacientidan erTs gamouvlinda hiperprolaqtinemia da galaqtorea.
agreTve, Cvens mier Catarebuli kvlevis ganmavlobaSi gamovlinda preparat ketileptis efeqturoba afeqturi speqtris aSlilobebis dros. aRniSnuli preparatis erTdrouli gamoyeneba antidepresantebTan kombinaciaSi (25-400 mg/dR) iZleoda depresiis efeqturi kupirebis saSualebas. preparati efeqturi iyo iseTi mdgomareobebis mkurnalobis dros, rogoricaa bipolaruli afeqturi aSliloba, monopolaruli rekurentuli depresiuli aSliloba, Sizoafeqturi aSliloba, rogorc depresiuli epizodis aseve maniakaluri epizodis dros antidepresantebTan da normoTimikebTan kombinaciaSi. aRniSnuli mdgomareobebis dros preparatis dozireba Seadgenda 25-400 mg/dR.
kvlevaSi CarTuli pacientebis absoluturma umravlesobam dadebiTad Seafasa preparatis efeqturoba da gamoTqva survili preparatis Semdgomi miRebis Taobaze.
daskvna
fsiqikuri janmrTelobis centr “mentalvita”-Si Catarebuli klinikuri dakvirvebidan miRebuli Sedegebis analizis Sedegad, kvlevaSi CarTuli eqim-fsiqiatrebi mividnen Semdeg daskvnamde:
preparati gansakuTrebiT efeqturia afeqturi speqtris aSlilobebis dros (bipolaruli afeqturi aSliloba, monopolaruli rekurentuli depresiuli aSliloba, Sizoafeqturi aSliloba).
preparati efeqturia Sozofreniuli da sxva haluciantorul-bodviTi mdgomareobebis dros qvemwvave da remisiis stadiaSi.
preparatis naklebi arasasurveli movlenebidan gamomdinare preparati komfortulia pacientisTvis misi xangrZlivi gamoyenebis SemTxvevaSi.
prepratis nawilobriv stimulaciuri efeqti swori dozirebis da sxva preparatebTan kombinaciis SemTxvevaSi sasargebloa negatiuri simptomebis nawilobrivi reducirebisTvis xangrZlivi miRebis dros.
literatura
1. A.C. Altamuraa, E. Mundoa , at al: Quetiapine and classical mood stabilizers in the long-term treatment of Bipolar Disorder: A 4-year follow-up naturalistic study” Journal of Affective Disorder Volume 110, Issue 1, Pages 135-141 (September 2008)
2. Bogart GT, Chavez B. “Safety and efficacy of quetiapine in bipolar depression.” Englewood Hospital and Medical Center , Englewood , NJ , USA.PMID: 19809011 [PubMed - in process]
3. Goldstein JM, et al. Unique mechanism of action for the antidepressant properties of the atypical antipsychotic quetiapine. Poster NR336 presented at the American Psychiatric Association 160th Annual Meeting, San Diego , California , 19-24 May, 2007
4. Laurie Barclay, MD “Quetiapine Well-Tolerated, Effective in Refractory Schizophrenia”. CINP Annual Meeting. June 2002
5. Montgomery S, et al. A randomised, placebo-controlled study of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in patients with major depressive disorder (MDD). Poster presented at the International Forum on Mood and Anxiety Disorders, Budapest , Hungary , 5-7 December, 2007
6. Riedel M, Muller N, Strassnig M,el all .”Quetiapine has equivalent efficacy and superior tolerability to risperidone in the treatment of schizophrenia with predominantly negative symptoms” Eur Arch Psychiatry Clin Neurosci 2005;255(6):432-437
7. S. Devarajan “Quetiapine Plus SSRI in Treatment-Resistant Depression”. Department of Psychiatry, University of Western Ontario , Canada , 2006
8. Small JG, Kolar MC, Kellams JJ.” Quetiapine in schizophrenia: onset of action within the first week of treatment”. Curr Med Res Opin 2004;20(7):1017-1023
Evaluation of clinical efficiency of Ketilept (Quetiapine) during schizophrenia, schizoaffective, delusional and affective disorder treatment
G.Sikharulidze, G.Naneishvili, N.Okribelashvili, V.Kenchadze
Centre of Mental Health “MENTALVITA”
The aim of the study was to examine efficiency of Ketilept during such kind of psychic disorders as schizophrenia, schizoaffective, delusional and affective disorders. Also the study was intended to provide particular recommendations for use of this medicament in different psychic conditions. In this study were involved 63 patients in the centre of mental health “MENTALVITA” from the next nosological groups of the international classification (ICD-10): affective disorders F30-F39, schizophrenia, schizotypal disorders F20-F29, disorders of organic nature F00-F09, , neurotic, stress-related and somatoform disorders F40-F48. The efficiency of Ketilept on patients’ psychic status was defined by approbated international questionnaires and the doctors’ personal experience: Positive symptoms assessment scale (SAPS); Negative symptoms assessment scale (SANS); Beck Depression Inventory (BDI II)
The number of inpatients involved in the study was 24, the number of outpatients – 39. Inpatient treatment dosage was 25-1000mg.
This medicament is particularly effective in treatment of affective disorders (Bipolar affective disorders, recurrent disorder, schizoaffective disorder)
The medicament is efficient with schizophrenic and other hallucinatory delusional cases during sub acute and remission phases.
With minor side effects this medicament is comfortable for prolonged use.
In case of correct dosage and combination with other medicaments partial stimulating effect of the medicament is efficient for partial reduction of negative symptoms, if used for a long period.