PHARMACOEPIDEMIOLOGICAL MONITORING HELPS IN REDUCING OF NEUROLEPTICINDUCED EXTRAPYRAMIDAL DISORDERS

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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
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Pharmacoepidemiological Monitoring Helps in
Reducing Neuroleptic-Induced Extrapyramidal
Disorders at the Psychiatric Clinical Hospital in
Tatarstan Ziganshina LE, Kuchaeva AV, Gatin FF,
Minnetdinova LM Kazan State Medical Academy and
Republican Clinical Psychiatric Hospital, Russia
Problem 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 20002002. 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 (20012002). The subsequent drug
use study was performed in 2002. Outcome
Measures Total daily doses of neuroleptics (in
terms of oral chlorpromazine and defined daily
doses), the WHO drug use indicators. ResultsThe
total daily dose of neuroleptics in patients with
paranoid schizophrenia with hallucinative-paranoid
al 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.
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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.
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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.

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Methods

• Clinical Psychiatric Hospital of the Ministry of
  Health of the Republic of Tatarstan (gt2000 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.

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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
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Prescribed daily doses of neuroleptics (in DDDs)
in patients men and women, causing movement
disorders (2000-2002).
plt0,05 difference between women and men.
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Comparison of the number of cases of
extrapyramdal movement disorders in women and men
with various forms of schizophrenia (2000-2002).

• -? lt 0,05 - level of statistical significance of
  distinctions between women and men.

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

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ConclusionsThe 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.
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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