TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
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<strong>TEYXOS</strong> <strong><strong>17</strong>2</strong> 3/<strong>17</strong>/<strong>09</strong> <strong>11</strong>:14 <strong>AM</strong> <strong>Page</strong> 54<br />
Σ Υ Ν Τ Ο Μ Η Ε Ν Η Μ Ε Ρ Ω Σ Η<br />
Οι συγγρ<strong>α</strong>φ<strong>ε</strong>ίς<br />
κ<strong>α</strong>τ<strong>α</strong>λήγουν στο<br />
συ<strong>μ</strong>πέρ<strong>α</strong>σ<strong>μ</strong><strong>α</strong> ότι τ<strong>α</strong><br />
<strong>α</strong>ντιψυχωτικά φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong><br />
θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong><br />
θ<strong>ε</strong>ωρούντ<strong>α</strong>ι <strong>ε</strong>πικίνδυν<strong>α</strong><br />
γι<strong>α</strong> τ<strong>α</strong> ηλικιω<strong>μ</strong>έν<strong>α</strong><br />
άτο<strong>μ</strong><strong>α</strong>.<br />
54 / MEDICAL EXPRESS / TEYXOΣ <strong><strong>17</strong>2</strong> / ΜΑΡΤΙΟΣ 20<strong>09</strong><br />
Σ<strong>ε</strong> <strong>μ</strong>ι<strong>α</strong> πρόσφ<strong>α</strong>τη <strong>μ</strong><strong>ε</strong>λέτη <strong>α</strong>σθ<strong>ε</strong>νών <strong>μ</strong><strong>ε</strong> στ<strong>ε</strong>φ<strong>α</strong>νι<strong>α</strong>ί<strong>α</strong><br />
νόσο κ<strong>α</strong>ι κ<strong>α</strong>τάθλιψη, οι SSRI <strong>α</strong>ποδ<strong>ε</strong>ίχτηκ<strong>ε</strong><br />
ότι <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>σφ<strong>α</strong>λ<strong>ε</strong>ίς <strong>α</strong>ν κ<strong>α</strong>ι <strong>α</strong>πέτυχ<strong>α</strong>ν<br />
ν<strong>α</strong> <strong>μ</strong><strong>ε</strong>ιώσουν τον κίνδυνο γι<strong>α</strong> κ<strong>α</strong>ρδι<strong>α</strong>κή<br />
νοσηρότητ<strong>α</strong> ή θνησι<strong>μ</strong>ότητ<strong>α</strong> (JW 15 / 2 /<br />
2005, σ.32 κ<strong>α</strong>ι J<strong>AM</strong>A 2007, 297: 367).<br />
Βιβλιογρ<strong>α</strong>φί<strong>α</strong>: Sherwood A et al.<br />
Relationship of depression to death or<br />
hospitalization in patients with heart<br />
failure. Arch Intern Med 2007 Feb 26;<br />
167: 367 – 73.<br />
Αντιψυχωτικά<br />
κ<strong>α</strong>ι θνησι<strong>μ</strong>ότητ<strong>α</strong><br />
Το 2005, η Δι<strong>ε</strong>ύθυνση Τροφί<strong>μ</strong>ων κ<strong>α</strong>ι Φ<strong>α</strong>ρ<strong>μ</strong>άκων<br />
των ΗΠΑ (FDA) δη<strong>μ</strong>οσί<strong>ε</strong>υσ<strong>ε</strong> έν<strong>α</strong><br />
συ<strong>μ</strong>βουλ<strong>ε</strong>υτικό έντυπο – βάσ<strong>ε</strong>ι των συγκ<strong>ε</strong>ντρωτικών<br />
<strong>α</strong>ποτ<strong>ε</strong>λ<strong>ε</strong>σ<strong>μ</strong>άτων κλινικών<br />
<strong>μ</strong><strong>ε</strong>λ<strong>ε</strong>τών – <strong>α</strong>ν<strong>α</strong>φορικά <strong>μ</strong><strong>ε</strong> την <strong>α</strong>υξη<strong>μ</strong>ένη<br />
θνησι<strong>μ</strong>ότητ<strong>α</strong> ηλικιω<strong>μ</strong>ένων <strong>α</strong>σθ<strong>ε</strong>νών <strong>μ</strong><strong>ε</strong><br />
άνοι<strong>α</strong>, οι οποίοι λά<strong>μ</strong>β<strong>α</strong>ν<strong>α</strong>ν άτυπ<strong>α</strong> <strong>α</strong>ντιψυχωτικά<br />
φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> ως θ<strong>ε</strong>ρ<strong>α</strong>π<strong>ε</strong>ί<strong>α</strong>. Επιπλέον,<br />
<strong>μ</strong>ι<strong>α</strong> <strong>α</strong>ν<strong>α</strong>δρο<strong>μ</strong>ική <strong>μ</strong><strong>ε</strong>λέτη που δι<strong>ε</strong>ν<strong>ε</strong>ργήθηκ<strong>ε</strong><br />
στις ΗΠΑ έδ<strong>ε</strong>ιξ<strong>ε</strong> ότι ο κίνδυνος<br />
θνησι<strong>μ</strong>ότητ<strong>α</strong>ς που δι<strong>α</strong>τρέχουν <strong>α</strong>υτοί οι<br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς <strong>ε</strong>νδέχ<strong>ε</strong>τ<strong>α</strong>ι ν<strong>α</strong> <strong>ε</strong>ίν<strong>α</strong>ι <strong>α</strong>κό<strong>μ</strong><strong>α</strong> υψηλότ<strong>ε</strong>ρος<br />
<strong>μ</strong><strong>ε</strong> τ<strong>α</strong> συ<strong>μ</strong>β<strong>α</strong>τικά <strong>α</strong>ντιψυχωτικά<br />
φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> (JW 1 / 1 / 2006, σ.<strong>11</strong> κ<strong>α</strong>ι N<br />
Engl J Med 2005, 353: 2335). Τώρ<strong>α</strong> οι<br />
<strong>ε</strong>ρ<strong>ε</strong>υνητές <strong>α</strong>σχολήθηκ<strong>α</strong>ν <strong>μ</strong><strong>ε</strong> το ίδιο ζήτη<strong>μ</strong><strong>α</strong><br />
χρησι<strong>μ</strong>οποιώντ<strong>α</strong>ς <strong>μ</strong>ι<strong>α</strong> βάση δ<strong>ε</strong>δο<strong>μ</strong>ένων<br />
<strong>α</strong>πό τη Βρ<strong>ε</strong>τ<strong>α</strong>νική Κολο<strong>μ</strong>βί<strong>α</strong>.<br />
Από το 1996 ως το 2004, π<strong>ε</strong>ρίπου<br />
37.000 άτο<strong>μ</strong><strong>α</strong> ηλικί<strong>α</strong>ς ?65 <strong>ε</strong>τών (<strong>μ</strong>έση<br />
ηλικί<strong>α</strong>, 80 <strong>ε</strong>τών) έλ<strong>α</strong>β<strong>α</strong>ν την πρώτη τους<br />
ι<strong>α</strong>τρική συντ<strong>α</strong>γή γι<strong>α</strong> <strong>α</strong>ντιψυχωτικά φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong>:<br />
π<strong>ε</strong>ρίπου <strong>13</strong>.000 έλ<strong>α</strong>β<strong>α</strong>ν κάποιο<br />
συ<strong>μ</strong>β<strong>α</strong>τικό φάρ<strong>μ</strong><strong>α</strong>κο (συχνότ<strong>ε</strong>ρ<strong>α</strong> λοξ<strong>α</strong>πίνη),<br />
<strong>ε</strong>νώ π<strong>ε</strong>ρίπου 24.000 έλ<strong>α</strong>β<strong>α</strong>ν άτυπ<strong>α</strong><br />
<strong>α</strong>ντιψυχωτικά φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> (συνήθως ρισπ<strong>ε</strong>ριδόνη).<br />
Το ποσοστό θνησι<strong>μ</strong>ότητ<strong>α</strong>ς <strong>ε</strong>ντός<br />
180 η<strong>μ</strong><strong>ε</strong>ρών ήτ<strong>α</strong>ν 14,1% στην ο<strong>μ</strong>άδ<strong>α</strong><br />
λήψης συ<strong>μ</strong>β<strong>α</strong>τικού <strong>α</strong>ντιψυχωτικού φ<strong>α</strong>ρ<strong>μ</strong>άκου<br />
κ<strong>α</strong>ι 9,6% στην ο<strong>μ</strong>άδ<strong>α</strong> λήψης άτυπου<br />
<strong>α</strong>ντιψυχωτικού φ<strong>α</strong>ρ<strong>μ</strong>άκου. Σ<strong>ε</strong> <strong>α</strong>ρκ<strong>ε</strong>τές<br />
<strong>α</strong>ν<strong>α</strong>λύσ<strong>ε</strong>ις, που προσ<strong>α</strong>ρ<strong>μ</strong>όστηκ<strong>α</strong>ν<br />
σύ<strong>μ</strong>φων<strong>α</strong> <strong>μ</strong><strong>ε</strong> πιθ<strong>α</strong>νές συγχυτικές <strong>μ</strong><strong>ε</strong>τ<strong>α</strong>βλητές,<br />
η θνησι<strong>μ</strong>ότητ<strong>α</strong> π<strong>α</strong>ρέ<strong>μ</strong><strong>ε</strong>ιν<strong>ε</strong> σ<strong>ε</strong> στ<strong>α</strong>τιστικά<br />
ση<strong>μ</strong><strong>α</strong>ντικά β<strong>α</strong>θ<strong>μ</strong>ό σ<strong>ε</strong> υψηλότ<strong>ε</strong>ρ<strong>α</strong><br />
<strong>ε</strong>πίπ<strong>ε</strong>δ<strong>α</strong> στους λήπτ<strong>ε</strong>ς συ<strong>μ</strong>β<strong>α</strong>τικού <strong>α</strong>ντιψυχωτικού<br />
φ<strong>α</strong>ρ<strong>μ</strong>άκου, σ<strong>ε</strong> σύγκριση <strong>μ</strong><strong>ε</strong><br />
<strong>ε</strong>κ<strong>ε</strong>ίνους που λά<strong>μ</strong>β<strong>α</strong>ν<strong>α</strong>ν κάποιο άτυπο<br />
<strong>α</strong>ντιψυχωτικό φάρ<strong>μ</strong><strong>α</strong>κο (<strong>α</strong>ν<strong>α</strong>λογί<strong>α</strong> θνησι<strong>μ</strong>ότητ<strong>α</strong>ς,<br />
π<strong>ε</strong>ρίπου 1,3 προς 1,4).<br />
Σχόλιο: Τ<strong>α</strong> <strong>α</strong>ποτ<strong>ε</strong>λέσ<strong>μ</strong><strong>α</strong>τ<strong>α</strong> <strong>α</strong>υτά <strong>ε</strong>ίν<strong>α</strong>ι<br />
π<strong>α</strong>ρό<strong>μ</strong>οι<strong>α</strong> <strong>μ</strong><strong>ε</strong> <strong>ε</strong>κ<strong>ε</strong>ίν<strong>α</strong> της <strong>α</strong>ντίστοιχης<br />
<strong>μ</strong><strong>ε</strong>λέτης <strong>α</strong>πό τις ΗΠΑ, την οποί<strong>α</strong> <strong>α</strong>ν<strong>α</strong>φέρ<strong>α</strong><strong>μ</strong><strong>ε</strong><br />
π<strong>α</strong>ρ<strong>α</strong>πάνω. Έχου<strong>μ</strong><strong>ε</strong> πλέον στοιχ<strong>ε</strong>ί<strong>α</strong><br />
<strong>α</strong>πό τυχ<strong>α</strong>ιοποιη<strong>μ</strong>έν<strong>ε</strong>ς <strong>μ</strong><strong>ε</strong>λέτ<strong>ε</strong>ς που<br />
δ<strong>ε</strong>ίχνουν ότι η λήψη άτυπων <strong>α</strong>ντιψυχωτικών<br />
φ<strong>α</strong>ρ<strong>μ</strong>άκων <strong>α</strong>υξάν<strong>ε</strong>ι τη θνησι<strong>μ</strong>ότητ<strong>α</strong><br />
ηλικιω<strong>μ</strong>ένων <strong>α</strong>τό<strong>μ</strong>ων <strong>μ</strong><strong>ε</strong> άνοι<strong>α</strong> κ<strong>α</strong>ι<br />
τ<strong>α</strong> στοιχ<strong>ε</strong>ί<strong>α</strong> <strong>μ</strong>ι<strong>α</strong>ς <strong>μ</strong><strong>ε</strong>λέτης π<strong>α</strong>ρ<strong>α</strong>τήρησης<br />
που δ<strong>ε</strong>ίχνουν ότι τ<strong>α</strong> συ<strong>μ</strong>β<strong>α</strong>τικά <strong>α</strong>ντιψυχωτικά<br />
φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> <strong>ε</strong>νδέχ<strong>ε</strong>τ<strong>α</strong>ι ν<strong>α</strong> <strong>ε</strong>πιφέρουν<br />
<strong>α</strong>κό<strong>μ</strong><strong>α</strong> υψηλότ<strong>ε</strong>ρο κίνδυνο στο<br />
συγκ<strong>ε</strong>κρι<strong>μ</strong>ένο πληθυσ<strong>μ</strong>ό. Η <strong>μ</strong><strong>ε</strong>λέτη<br />
<strong>α</strong>υτή δ<strong>ε</strong>ν κ<strong>α</strong>τάφ<strong>ε</strong>ρ<strong>ε</strong> ν<strong>α</strong> <strong>α</strong>ν<strong>α</strong>φέρ<strong>ε</strong>ι τους<br />
λόγους που χορηγήθηκ<strong>α</strong>ν τ<strong>α</strong> συγκ<strong>ε</strong>κρι<strong>μ</strong>έν<strong>α</strong><br />
φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> ή τους πιθ<strong>α</strong>νούς <strong>μ</strong>ηχ<strong>α</strong>νισ<strong>μ</strong>ούς<br />
<strong>μ</strong>έσω των οποίων <strong>μ</strong>πορ<strong>ε</strong>ί ν<strong>α</strong><br />
συντέλ<strong>ε</strong>σ<strong>α</strong>ν στην <strong>α</strong>ύξηση της θνησι<strong>μ</strong>ότητ<strong>α</strong>ς.<br />
Ωστόσο, οι συγγρ<strong>α</strong>φ<strong>ε</strong>ίς κ<strong>α</strong>τ<strong>α</strong>λήγουν<br />
στο συ<strong>μ</strong>πέρ<strong>α</strong>σ<strong>μ</strong><strong>α</strong> ότι τ<strong>α</strong> <strong>α</strong>ντιψυχωτικά<br />
φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> θ<strong>α</strong> πρέπ<strong>ε</strong>ι ν<strong>α</strong> θ<strong>ε</strong>ωρούντ<strong>α</strong>ι<br />
<strong>ε</strong>πικίνδυν<strong>α</strong> γι<strong>α</strong> τ<strong>α</strong> ηλικιω<strong>μ</strong>έν<strong>α</strong> άτο<strong>μ</strong><strong>α</strong>.<br />
Βιβλιογρ<strong>α</strong>φί<strong>α</strong>:<br />
Schnesweiss S et al. Risk of death<br />
associated with the use conventional<br />
versus atypical antipsychotic drugs<br />
among elderly patients. CMAJ 2007<br />
2007 Feb 27; <strong>17</strong>6: 627 – 32.<br />
Μόνι<strong>μ</strong>ος κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>α</strong>ς<br />
σ<strong>ε</strong> ηλικιω<strong>μ</strong>ένους<br />
Οι <strong>μ</strong>όνι<strong>μ</strong>οι ουρηθρικοί κ<strong>α</strong>θ<strong>ε</strong>τήρ<strong>ε</strong>ς τύπου<br />
Foley τοποθ<strong>ε</strong>τούντ<strong>α</strong>ι συχνά σ<strong>ε</strong> ηλικιω<strong>μ</strong>ένους<br />
<strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς κ<strong>α</strong>τά τη νοσηλ<strong>ε</strong>ί<strong>α</strong> τους<br />
σ<strong>ε</strong> νοσοκο<strong>μ</strong><strong>ε</strong>ίο, ορισ<strong>μ</strong>έν<strong>ε</strong>ς φορές γι<strong>α</strong><br />
συγκ<strong>ε</strong>κρι<strong>μ</strong>ένους ι<strong>α</strong>τρικούς λόγους κ<strong>α</strong>ι<br />
άλλ<strong>ε</strong>ς φορές γι<strong>α</strong> τη δι<strong>ε</strong>υκόλυνση του<br />
νοσηλ<strong>ε</strong>υτικού προσωπικού. Σ<strong>ε</strong> <strong>α</strong>υτή τη<br />
<strong>μ</strong><strong>ε</strong>λέτη, οι <strong>ε</strong>ρ<strong>ε</strong>υνητές προσπάθησ<strong>α</strong>ν ν<strong>α</strong><br />
προσδιορίσουν <strong>ε</strong>άν κ<strong>α</strong>ι κ<strong>α</strong>τά πόσο η χρήση<br />
κ<strong>α</strong>θ<strong>ε</strong>τήρων χωρίς ι<strong>α</strong>τρικές <strong>ε</strong>νδ<strong>ε</strong>ίξ<strong>ε</strong>ις<br />
συσχ<strong>ε</strong>τίζ<strong>ε</strong>τ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong> <strong>α</strong>ν<strong>ε</strong>πιθύ<strong>μ</strong>ητ<strong>ε</strong>ς <strong>ε</strong>κβάσ<strong>ε</strong>ις.<br />
Η <strong>ε</strong>ρ<strong>ε</strong>υνητές χρησι<strong>μ</strong>οποίησ<strong>α</strong>ν δ<strong>ε</strong>δο<strong>μ</strong>έν<strong>α</strong><br />
που συλλέχθηκ<strong>α</strong>ν προοπτικά <strong>α</strong>πό <strong>μ</strong>ι<strong>α</strong><br />
προγ<strong>ε</strong>νέστ<strong>ε</strong>ρη δη<strong>μ</strong>οσι<strong>ε</strong>υ<strong>μ</strong>ένη κλινική<br />
<strong>μ</strong><strong>ε</strong>λέτη, που π<strong>ε</strong>ριλά<strong>μ</strong>β<strong>α</strong>ν<strong>ε</strong> <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς ηλικί<strong>α</strong>ς<br />
≥ 70 <strong>ε</strong>τών (<strong>μ</strong>έση ηλικί<strong>α</strong>, π<strong>ε</strong>ρίπου 80<br />
<strong>ε</strong>τών), οι οποίοι νοσηλ<strong>ε</strong>ύοντ<strong>α</strong>ν στην<br />
π<strong>α</strong>θολογική <strong>μ</strong>ονάδ<strong>α</strong> <strong>ε</strong>νός νοσοκο<strong>μ</strong><strong>ε</strong>ίου.<br />
Από τους 535 <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς χωρίς κάποι<strong>α</strong>
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