engleski

The correlation of therapeutic adherence among adolescent and adult patients with psychosis using a HPLC&LC-MS method

Introduction: The contemporary data show how adherence of patients with mental illness is still inadequate. In time period of one year, about three-quarters of patients prescribed psychotropic medication will discontinue making this decision themselves without consulting their health professional. Nonadherence to antipsychotic medication regimens represents an important issue which leads to increased treatment costs and serious concequences. As many as 60% of patients with schizophrenia do not take their medications as prescribed. This can derail the process of recovery, lead to successive hospitalization and diminish the posibility of functional rehabilitation in order to participate adequatley in one' s social environment [1]. Therefore, for optimal treatment of patients therapeutic drug monitoring (TDM) is useful for drugs such as: antipsychotic, antidepressants and benzodiazepines. This helps to reduce non- compliance, adverse effects, non-response or “resistance” and intoxications. Relatively low cost and available method is high performance liquid chromatography (HPLC) in combination with liquid chromatography-mass spectrometry (LC-MS). The LC-MS is also an analytical chemistry tehnique that combines the physical separation capabilities of liquid chromatography (HPLC) with mass analysis capabilities of mass spectrometry (MS) [2, 3]. Aim of the study: To objectively determine the therapeutic adherence with therapeutic drug monitoring (TDM) of patients with psychotic disorders in two different population: adolescents and adults and one's who were frequently hospitalized due relapses/possible nonadherence despite taking peroral antipsychotic medication. Methods: The study was conducted on Psychiatric Clinic in Clinical Hospital Centre Osijek (Croatia) and in two different departments: Child and Adolescent Psychiatry Department and on Department of Biological psychiatry with intensive care and in co-operation with our specialized Molecular Laboratory. All patients had a diagnosis of psychotic disorder accoridng to ICD-X (F20.x ; F23.x ; F28, F29). Adolescent group was consisted of ages 15–18 years old (equally males and females) and adult group had a span of 18–35 year old of equally distributed both sexes. Each group (divided by sex) consisted of 30 patients. All patients have signed the informed consent. We have observed concentrations of these antipsychotics int he blood: risperidone, olanzapine, quetiapine. The blood sample was taken only upon addmitance of a patient to the specific psychiatric department and was processed in the laboratory with two consecutive methods: high performance liquid chromatography and liquid chromatography-mass spectrometry. Summary and Conclusion: Our study showed somewhat dissapointing results. In the group of adults, almost one-half of adult male patients had inadequate concentrations of antipsychotics in their blood sample, especially quetiapine and olanzapine. One-third in the group of adult female patients showed low concetrations of olanzapine and one-fourth reduced concetrations of risperidone. In the group of adolescents only one-fourth had borderline low antipsychotic concentrations. We believe these differences between adults and adolescents were due to inadequate lifestyles in the group of adults and parental care in adolescent group. No matter results, we find these methods valuable for our clinical practice due to objective validation of treatment and are planning to expand this study and also implement these methods in everyday practice among high-risk for nonadherence patients.

schizophrenia; clinical drug monitoring; pharmacokinetics

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