Liječenje rezistentne shizofrenije

master's thesis

• Title (english): Treatment of resistant schizophrenia
• Author: Antonija Medić
• Mentor: Miroslav Herceg (mentor)
• Committee member: Miroslav Herceg (predsjednik povjerenstva)
• Committee member: Ninoslav Mimica (član povjerenstva)
• Committee member: Dražen Begić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Psychiatry and Psychological Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Psychiatry

Abstract

Shizofrenija je psihijatrijska bolest od koje obolijeva jedan posto populacije. Najčešća zahvaća mlade ljude. Primarno se liječi tipičnim i atipičnim antipsihoticima.
Rezistentna shizofrenija se dijagnosticira kad se ne primijeti odgovor na liječenje dvama različitim antipsihoticima od kojih je jedan atipičan. Liječenje mora biti provedeno u odgovarajućoj dozi i trajanju. Klozapin je zlatni standard u liječenju rezistentne shizofrenije. Pokazao se superiornim u odnosu na ostale antipsihotike u različitim istraživanjima. Osim veće učinkovitosti, njegova prednost je i to što ne izaziva ekstrapiramidne nuspojave. Za vrijeme terapije klozapinom potrebno je provoditi redovite pretrage krvne slike kao probir za agranulocitozu. Dvadeset do trideset posto pacijenata sa shizofrenijom boluje od rezistentnog oblika, a šezdeset posto od njih boluje od ultrarezistentnog oblika u kojem izostaje odgovor i na klozapin. Dakle, dvanaest do osamnaest posto svih pacijenata oboljelih od shizofrenije ne odgovara ni na kakav oblik liječenja.
Pokušaji povećanja učinka klozapina učinjeni su povećanjem doze monoterapije, korištenjem kombinacije antipsihotika te kombinacijom klozapina s drugim grupama lijekova. Nažalost, ove metode povećavanja nisu se još dokazale kao dovoljno učinkovite da bi bile uključene u standardni terapijski algoritam. S druge strane, elektrokonvulzivna terapija je neuromodulacijska metoda koja djeluje obećavajuće za povećanje terapijskog uspjeha.
Iako su brojne metode liječenja istražene, rezistentna shizofrenija ostaje klinički izazov koji pogađa značajan postotak populacije i zahtijeva daljnja istraživanja.

Abstract (english)

Schizophrenia is a psychiatric disease which affects one percent of population. It is most common in young adults. It is primarily treated with typical and atypical antipsychotics.
Resistant schizophrenia is a condition diagnosed after no response is noticed to two different antipsychotics of which one is atypical. The treatment has to be undertaken with adequate doses and duration of therapy. Clozapine is the golden standard in the treatment of therapy-resistant schizophrenia. It has shown its superiority among other antipsychotics in various studies. Aside from greater effectiveness, advantages include absence of extrapyramidal side effects. During clozapine treatment, regular blood tests should be performed as a screening method for agranulocytosis. Twenty to thirty percent od schizophrenia patients suffer from treatment resistant schizophrenia. Sixty percent of the latter ones show no therapeutic response to clozapine. In conclusion twelve to eighteen percent of all patients suffering from schizophrenia show no response to any form of treatment.
Attempts to augment clozapine effectiveness are being made by increasing the dose of monotherapy, using antipsychotic polipharmacy or adding other types of drugs to clozapine. Unfortunately, these augmentation methods have not yet proven themselves to be effective enough to be added to standard therapy algorythms. On the other hand, electroconvulsive therapy is neuromodulatory method that shows promise in increasing therapeutic success.
lthough many methods of treatment are being researched, therapy-resistant schizophrenia remains a clinical challenge which affects a significant percentage of population and will require additional research.

• Keywords: shizofrenija; liječenje; klozapin; elektrokonvulzivna terapija
• Keywords (english): schizophrenia; treatment; clozapine; electroconvulsive therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:920966
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-11-18 10:04:35