1. OF PHARMACOLOGICAL TREATMENT IN PATIENTS WITH SEVERE MENTAL ILLNESS
IMPACT OF ASSERTIVE COMMUNITY TREATMENT IN THE OPTIMIZATION
OF PHARMACOLOGICAL TREATMENT IN PATIENTS WITH SEVERE MENTAL ILLNESS
María-José Alvarez, Pere Roura-Poch, Núria Riera, Clara Blanch, Ana Martin, Judit Pons, Josep-Manel Santos, Francesc Arrufat
Vic Hospital Consortium & Mental Health and Social Innovation Research Vic University Group .
Vic, Barcelona, Spain
BACKGROUND
In order to deinstitutionalize patients with severe mental illness, in 1980, Stein described in USA the Assertive Community Treatment (ACT) model, characterized as an individualized, intensive, multidisciplinary treatment.
The antipsychotic drugs are the mainstream of medical treatment of these disorders. Nevertheless, despite recommendations from different clinical guidelines about not exceeding recommended doses, the clinical practice suggests the frequent use of higher dose, which increases some safety problems. Benzodiazepines are another group of psychotropic drugs long-term used in patients with severe mental disorders; however, a recent meta-analysis (Dold, 2013) suggests that this type of psychotropic drugs are not suitable for maintenance therapy in psychotic patients, indicating its usefulness in short, specific periods. The ACT allows decrease significantly the antipsychotic dose (Satake, 2011)
The aim of this study is to analyze the changes in treatment of two groups of psychotropic drugs (antipsychotics and benzodiazepines) in patients with severe mental disorders at inclusion to and at discharge from an ACT program.
METHODOLOGY
A retrospective study was designed to include patients with severe mental disorder, functional impairment and a course of disease for more than two years to an ACT program. The program was scheduled in a Catalonia midlands county mental health centre. Data on benzodiazepines and antipsychotics dose prescribed were obtained from medical records, and a case report form was used to collect clinical and drug data. Dose of benzodiazepines was converted to equivalent dose of diazepam, and dose of antipsychotics (oral and long-acting) was converted to equivalent dose of olanzapine. Age, gender, diagnostic and relapse were also registered.
Percentages and frequencies are shown for qualitative variables and average, standard deviation or percentiles are shown for quantitative ones. Bivariate analysis was conducted under parametric or not parametric assumptions and differences between inclusion and discharge were conducted under paired tests.
RESULTS
A sample of 98 patients who did 106 entrances to ACT program were included to the study. The average of age years was 40.1 years (SD 12.8 years) and 59% were males. The patients were classified into three diagnostic categories. Schizophrenia spectrum patients with 73 patients (74.5%) included schizophrenic, schizoaffective and schizotypical personality disorder patients. In affective disorder group were included 19 patients (19.4%) with severe major depressive disorder and bipolar disorder. Six (6.1%) patients with obsessive compulsive disorder, dissociative disorder, or borderline personality disorder were classified as Other diagnoses group.
On antipsychotic drugs, a paired T test showed statistical significant differences (p<0.05) between inclusion and discharge in global group and in schizophrenia spectrum group who showed an average reduction of 6 mg. On benzodiazepines, statistical significant differences were found in global group and in each one of three diagnoses categories (paired T test, p<0.05): an average reduction of 10 mg was observed in schizophrenia spectrum and of 20 mg in affective disorder group.
Dosage of Benzodiacepines
(in Diazepam mg equivalents)
Dosage of Antipsychotics
(in Olanzapine mg equivalents)
DISCUSSION
Most of the patients with severe mental illness who were included in the ACT program had a schizophrenic spectrum disorder. The ACT program multidisciplinary approach allows a dose reduction of both antipsychotic and benzodiazepine drugs, and specifically in schizophrenic spectrum patients. We conclude that ACT program is useful optimizing the dosage of psychoactive medication, improving the therapeutic safety and, as a consequence, reducing pharmacological spending.
The 5th Biennial Schizophrenia International Research Society Conference, 2-6 April 2016 Florence, Italy