Pharmacotherapy of Mental Illness in the Mental Health Centers in Kosovo During 2021

Fitim Alidema; Viktor Isjanovski; Arieta Hasani-Alidema; Behrije Halilaj-Vishi; Minire Alilaj-Beqiraj

doi:10.3889/oamjms.2022.10395

Authors

Fitim Alidema Department of Medical Science, Faculty of Pharmacy, UBT College, Prishtina, Kosovo https://orcid.org/0000-0002-3827-4563
Viktor Isjanovski Psychiatric Hospital, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Arieta Hasani-Alidema Department of Medical Science, Faculty of Pharmacy, UBT College, Prishtina, Kosovo; Department of Neurology, University Clinical Center of Kosovo, Prishtina, Kosovo
Behrije Halilaj-Vishi Department of Gyneacology, Regiona Hospital, Ferizaj, Kosovo
Minire Alilaj-Beqiraj Department of Medical Science, Faculty of Pharmacy, UBT College, Prishtina, Kosovo; Department of Gyneacology, Regiona Hospital, Ferizaj, Kosovo

DOI:

https://doi.org/10.3889/oamjms.2022.10395

Keywords:

Pharmacotherapy, Mental illness, Mental Health Centers Kosovo

Abstract

Background- Treatment of mental illness with pharmacotherapy is strictly monitored in clinical centers dedicated to this purpose. While in most of developed countries this practice is well established, in Kosovo, in absence of such system, there is the need for further and continues investigation in this context with the aim to better monitor the therapy.

Aim of the study - This work aims to analyze and investigate the treatment of the patients with mental illness in the Mental Health Centers in Kosovo.

Methods - The methodology of this research work is based on the specific guidelines published by the WHO. Handbook of the World Health Organization (WHO). All patients’ data were obtained from protocol books of the treated patients. For each city, 30 patients which were selected according to the theory of probability, were analyzed. A total of 209 patients were enrolled in the study. Regarding the pharmacotherapeutic characteristics we have analyzed the way of treatment of mental illnesses according to the groups of drugs and centers. The diseases were categorized according to the International Classification of Diseases - Revision 10.

Results - Drugs were mainly administered through mouth, per os (PO) (82.4%). According to the clinics there was no significant change as per administration route of the drugs (ChiTest = 28, p > 0.11) (Tab.3). Almost, 2/3 of the prescribed drugs were non-essential (66.1%). Considering the class of the therapeutic drugs, over half of them were antipsychotic (53.2%), whereas in a percentage of 17.2% and 13.8% were anticholinergic and anxiolytic/hypnotic drugs, accordingly. These classes of drugs were 84.2% of the overall used drugs. Taken together, In the Mental Health Centers in Kosovo, drugs are mainly administered orally, with only 17.6% of the cases treated parenterally. The majority of the drugs used are the non-essential drugs, with antipsychotics being the most prescribed ones.

Conclusions - Furthermore, the study highlights the use of the third-line therapy as a first choice, and the use of effective drugs with low safety profile such as: Clozapine 84.62% (from SDA group). Moreover, ineffective drugs are used in 1.92% of patients and non-compliance of treatment with drug indications was found in 5.77% of cases.

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References

Sayers J. The World Health Report 2001 – Mental Health: New Understanding, New Hope. PubMed Central (PMC); June, 2022.

Kumar N, Adhikari T, Singh J, Tiwari N, Acharya A. Health data from diaries used in low-income communities, north India. Bull World Health Organ. 2021;99(6):446-54. https://doi.org/10.2471/BLT.20.264325 PMid:34108755 DOI: https://doi.org/10.2471/BLT.20.264325

Kapczinski F, Amaral O, Madruga M, Quevedo J, Busnello J, de Lima M. Use and misuse of benzodiazepines in Brazil: A review. Subst Use Misuse. 2001;36(8):1053-69. https://doi.org/10.1081/ja-100104489 PMid:11504152 DOI: https://doi.org/10.1081/JA-100104489

Dayan A. Book reviews: Goodman & Gilman’s the pharmacological basis of therapeutics – Ninth edition. Hum Exp Toxicol. 1996;15(7):605. DOI: https://doi.org/10.1177/096032719601500711

Pikalov A. American Psychiatric Association practice guidelines for the treatment of psychiatric disorders compendium 2002. Am J Psychiatry. 2003;160(8):1531-2. DOI: https://doi.org/10.1176/appi.ajp.160.8.1531

Lövdahl U, Riska E. The construction of gender and mental health in Nordic psychotropic-drug advertising. Int J Health Serv. 2000;30(2):387-406. https://doi.org/10.2190/E81E-T164-T0BG-RM05 PMid:10862382 DOI: https://doi.org/10.2190/E81E-T164-T0BG-RM05

Walker R. Clinical Pharmacy and Therapeutics. London: Churchill Livingstone; 2003.

Whittaker A. Critiques. Drug Alcohol Rev 2015;34:340-41. https://doi.org/10.1111/dar.12212 DOI: https://doi.org/10.1111/dar.12212

Enna S. Goodman & Gilman’s the pharmacological basis of therapeutics. Edited by Joel G. Hardman, Lee E. Limbird, Perry B. Molinoff, and Raymond W. Ruddon. McGraw-Hill, New York. 1996. J Med Chem. 1997;40(16):2657-8. DOI: https://doi.org/10.1021/jm9703146

World Health Organization. WHO MiNDbank – Improving Access and Use of Psychotropic Medicines (Mental Health Policy and Service Guidance Package – Module 10); 11 June, 2022.

World Health Organization. How to Develop and Implement a National Drug Policy; 11 June, 2022.

WHO. Promoting Rational Use of Medicines Core Components WHO Policy Perspectives of Medicines No. 5. Geneva: World Health Organization, References – Scientific Research Publishing; 2002. Available from: https://www.scirp.org/. [Last accessed on 2022 Jun 11].

Brown S, Inskip H, Barraclough B. Causes of the excess mortality of schizophrenia. Br J Psychiatry. 2000;177:212-7. http://doi.org/10.1192/bjp.177.3.212 PMid:11040880 DOI: https://doi.org/10.1192/bjp.177.3.212

McGlashan TH. A selective review of recent North America long-term follow up studies of schizophrenia. Schizophr Bull. 1988;14(4):515-42. http://doi.org/10.1093/schbul/14.4.515 PMid:3064280 DOI: https://doi.org/10.1093/schbul/14.4.515

Karasu TB, Waltzman SA, Lindenmayer JP, Buckley PJ. The medical care of patient with psychiatric illness. Hosp Community Psychiatry. 1980;31:463-72. DOI: https://doi.org/10.1176/ps.31.7.463

Bland RC, Parker JH, Orn H. Prognosis in schizophrenia a ten-year follow-up of first admission. Arch Gen Psychiatry. 1976;33:949-54. http://doi.org/10.1001/archpsyc.1976.01770080067006 PMid:949228 DOI: https://doi.org/10.1001/archpsyc.1976.01770080067006

Lieberman JA, Parkins D, Belger A, Chakos M, Jarskog F, Boteva K, et al. The early stage of schizophrenia: Speculation on pathogenesis, pathophysiology, and therapeutic approach. Biol Psychiatry. 2001;50(11):884-97. http://doi.org/10.1016/s0006-3223(01)01303-8 PMid:11743943 DOI: https://doi.org/10.1016/S0006-3223(01)01303-8

Stahl MS. Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. 2nd ed. Cambridge, UK: Cambridge University Press; 2000. p. 368-73.

Miller AL, Chiles JA, Chiles J, Crismon ML. TMAP Procedural Manual: Schizophrenia Module Physician Manual. Texas Medication Algorithm Project, Phase 3. Texa Department of Mental Health and Retardation, Austin; August, 1998.

Meltzer HY. Atypical antipsychotic drugs. In: Bloom FE, Kupfer DJ, editors. Psychopharamacology: The Fourth Generation of Progress. New York: Raven; 1995. p. 1277-86.

Small JG, Hirsch SR, Arvanitis LA, Miller BG, Link CG, et al. Quetiapine in patients with schizophrenia. Arch Gen Psychiatry. 1997;54:549-57. http://doi.org/10.1001/archpsyc.1997.01830180067009 PMid:9193196 DOI: https://doi.org/10.1001/archpsyc.1997.01830180067009

American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia. 2th ed. USA: American Psychiatric Association Publishing; 2003. p. 48.

Awad AG. Drug therapy in schizophrenia: Variability of outcome and prediction of response. Can J Psychiatry. 1989;34:711-20. http://doi.org/10.1177/070674378903400716 PMid:2572318 DOI: https://doi.org/10.1177/070674378903400716

Johnson DA. Observations on the use of long-acting depot neuroleptic injections in the maintenance therapy of schizophrenia. J Clin Psychiatry. 1984;45:13-21. PMid:6143743

Janicak PG, Davis JM, Preskorn SH, Ayd FJ Jr. Principles and Practice of Psychopharmacotherapy. Baltimore: Williams & Wilkins; 1993.

Sim K, Su A, Ungvary GS, Fujii S, Yang SY, Chong MY, et al. Depot antipsychotic use in schizophrenia: an East Asian perspective. Hum Psychopharmacol. 2004;19(2):103-9. http://doi.org/.1002/hup.571 PMid:14994320 DOI: https://doi.org/10.1002/hup.571

Pickar D, Litman RE, Konicki PE, Wolkowitz OM, Breier A. Neurochemical and neural mechanisms of positive and negativesymptoms in schizophrenia. In: Andreason NC, editor. Schizophrenia: Positive and Negative Symptoms and Syndromes, Modern Problems in Pharmacopsychiatry. Vol. 24. Basel: Kerger; 1990. p. 124-51. DOI: https://doi.org/10.1159/000418015

Joseph TD, Robert LT, Gary CY, Gary RM, Barbara DW, Michael LP. Pharmacotherapy: A Pathophysiologic Approach. 4th ed. Stamford, Connecticut: Appleton & Lange; 1999. p. 1126.

Lachaux B, Casabedaig F, Philippe A, Ardiet G. Pharmaco-epidemiology of antipsychotic prescription practices for schizophrenic patients 1995 and 1998 cross sectional surveys. Encephale. 2004;30(1):46-51. http://doi.org/10.1016/s0013-7006(04)95415-2 PMid:15029076 DOI: https://doi.org/10.1016/S0013-7006(04)95415-2

Rittmannsberger H. The use of drug monotherapy in psychiatric inpatient treatment. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26(3):547-51. http://doi.org/10.1016/s0278-5846(01)00306-2 PMid:11999906 DOI: https://doi.org/10.1016/S0278-5846(01)00306-2

Ito C, Kubota Y, Sato M. A prospective survey on drug choice for prescriptions for admitted patients with schizophrenia. Psychiatry Clin Neurosci. 1999;53(Suppl):S35-40. PMid:10560896

WHO. 12th WHO Model List of Essential Medicines. Geneva: World Health Organization; April 2002.

WHO. The Selection of Essential Medicines. WHO Policy Perspectives on Medicines No. 4. Geneva: World Health Organization; 2002b.

WHO. The Use of Common Stems in the Selection of International Nonproprietary Names (INN) for Pharmaceutical Substances. Geneva: World Health Organization; 1997a.

WHO. Improving access and use of psychotropic medicines. In: Mental Health Policy and Service Guidance Package. Geneva: WHO; 2004. p. 23.

Kennedy JL, Altar CA, Taylor DL, Degtiar I, Hornberger JC. The social and economic burden of treatment-resistant schizophrenia: A systematic literature review. Int Clin Psychopharmacol. 2014;29:63-76. http://doi.org/10.1097/YIC.0b013e32836508e6 PMid:23995856 DOI: https://doi.org/10.1097/YIC.0b013e32836508e6