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Treatment Guidelines for Patients with Schizophrenia Or Psychotic Disorder Who Are Hospitalized in a Psychiatry Clinic

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Treatment Guidelines for Patients with Schizophrenia Or Psychotic Disorder Who Are Hospitalized in a Psychiatry Clinic Review DOI: 10.5455/bcp.20140923115118 Treatment Guidelines for Patients with Schizophrenia or Psychotic Disorder who are Hospitalized in a Psychiatry Clinic Koksal Alptekin1, Alp Ucok2, Ahmet Ayer3, Ahmet Unal4, Atila Erol5, Hulya Ensari6, Murad Atmaca7, Halise Devrimci Ozguven8 ÖZET: ABS TRACT: Psikiyatri kliniğine yatırılan şizofreni ve Treatment guidelines for patients with psikotik bozukluğu olan hastaların tedavi schizophrenia or psychotic disorder who are rehberi hospitalized in a psychiatry clinic Şizofrenide hastaneye yatış, genellikle kendine veya In schizophrenia, hospitalization is generally indicated başkalarına ciddi tehdit oluşturan veya kendilerine for patients who pose a serious threat to themselves or bakamayacak derecede dezorganize olmuş ya da others, those who are disorganized to the extent of not sanrıların/varsanıların etkisi altında olan hastalar için to being able to look after themselves or who are 1Dokuz Eylül University, Faculty of endikedir. Avrupa ülkelerinden şizofreni hastalarının experiencing delusions/hallucinations. The steps to be Medicine, Department of Psychiatry, Izmir - Turkey akut yönetimi konusunda uzman, 19 psikiyatristin taken during the time hospitalization of patients with 2Istanbul University, Faculty of Medicine, Department of Psychiatry, oluşturduğu Hastane Ortamı Uzman Kurulu (Hospital schizophrenia and psychosis as determined by the Istanbul - Turkey 3Manisa Psychiatric Hospital, Setting Expert Committee [HSEC]) tarafından Hospital Setting Expert Committee (HSEC), consisting Manisa - Turkey 4Gaziantep University Faculty of belirlenmiş olan şizofrenili ve psikotik hastaların of 19 psychiatrists from Europe, who are specialists in Medicine, Department of Psychiatry, hastanede kaldıkları süre boyunca izlenmesi gereken the acute management of schizophrenia patients, have Gaziantep - Turkey 5Sakarya University Faculty of Medicine, basamaklar 7 başlık halinde ayrı algoritmalar been arranged under 7 topics in the form of algorithms Department of Psychiatry, Sakarya - Turkey (Algoritma 1- Akut psikotik atağın değerlendirilmesi; (Algorithm 1- Assessing the acute psychotic episode; 6Bolu Izzet Baysal Mental Health and Disease Research Hospital & Community Algoritma 2- Yataklı tedavi için tedavi hedeflerinin Algorithm 2- Defining treatment targets for inpatient Mental Health Center, Bolu - Turkey 7Fırat University Faculty of Medicine, tanımlanması; Algoritma 3- Acil durum yönetimi; treatment; Algorithm 3- Emergency management; Department of Psychiatry, Elazığ - Turkey 8Ankara University Faculty of Medicine, Algoritma 4- Yataklı tedavi sırasında tedavi hedeflerinin Algorithm 4- Defining treatment targets during Department of Psychiatry, tanımlanması; Algoritma 5- Hastaneye yatış sırasında inpatient treatment; Algorithm 5- Pharmacological Ankara - Turkey ilaç tedavisi; Algoritma 6- Yataklı tedavi sırasında ilaç treatment at the time of hospitalization; Algorithm 6- Corresponding author: Köksal Alptekin, dışı tedavi; Algoritma 7- İyilik halinin artırılması) Non-pharmacological treatment during inpatient Dokuz Eylül University, Faculty of Medicine, Psychiatry Department, şeklinde düzenlenmiştir. Bu rehberin ülkemizin treatment; Algorithm 7- Improvement of well-being. Izmir 35340 Balçova - Izmir koşullarına uygun şekilde revize edilmiş Türkiye The Turkish version of this guideline, which was revised E-ma il add ress: [email protected] versiyonu sekiz psikiyatri kliniğinde kullanılarak to meet the conditions in our country, was used and Date of submission: değerlendirilmiştir. Hastaneye yatırılan şizofreni tested in eight psychiatry clinics. Following these August 20, 2014 hastalarında bu algoritmaların uygulanması, hastaların algorithms for hospitalized schizophrenia patients may Date of acceptance: yönetiminde ve sosyal yaşama katılımlarının be helpful for doctors in managing the patients and September 23, 2014 hızlandırılmasında hekimlere yardımcı olabilir. facilitating their participation in social life. Declaration of interest: A. Unal, H.E.: The authors received honorarium for scientific activities from Anahtar sözcükler: şizofreni, tedavi, algoritma, Keywords: schizophrenia, treatment, algorithm, hospital the Janssen Pharmaceutical Companies of Johnson & Johnson. hastane tedavisi, tedavi rehberi treatment, treatment guideline K.A., A.A., A. Ucok, A.E., H.D.O., M.A.: The authors received honoraria for scientific activities from various pharmaceutical Kli nik Psikofarmakoloji Bulteni 2014;24(3):276-88 Bulletin of Clinical Psychopharmacology 2014;24(3):276-88 companies. 276 Klinik Psikofarmakoloji Bülteni, Cilt: 24, Sayı: 3, 2014 / Bulletin of Clinical Psychopharmacology, Vol: 24, N.: 3, 2014 - www.psikofarmakoloji.org Alptekin K, Ucok A, Ayer A, Unal A, Erol A, Ensari H, Atmaca M, Devrimci-Ozguven H INTRODUCTION conducted in the United Kingdom, the efficiency of an average of 9 days of hospitalization time was Schizophrenia is a mental disorder that compared to a period of 14 days4. The common impairs psychosocial functioning, leads to result of all studies indicates that the disability and usually lasts lifelong. There are three improvement in symptoms during long-term fundamental targets in the treatment of hospitalizations is not superior to that of short- schizophrenia:1 diminishing or eradicating the term hospitalizations in terms of social symptoms,2 improving psychosocial functioning adaptation and the time it takes the patient to and quality of life to a maximum degree, and3 return to the hospital5-15. supporting recovery in a way to help gain personal Another issue, not less important than the life goals. This treatment process involves mainly efficiency of hospitalization time is managing the two periods, the acute phase and the maintenance patient in the most effective way during phase. The acute phase begins with a new episode hospitalization. There are not adequate or an acute relapse of the symptoms and assessments and recommendations about the continues until the symptoms diminish or regress roadmap to be followed for hospitalized patients to a level of “recovery” expected by the patient. in the schizophrenia treatment guidelines The maintenance phase follows the acute phase prepared by the World Federation of Societies of and the treatment is continued therein. The Biological Psychiatry (WFSBP) and the American maintenance phase consists of a long-term Psychiatric Association (APA). Thus, doctors are in treatment period and rehabilitation1. need of detailed diagnosis and treatment In schizophrenia, hospitalization is generally guidelines for patients with schizophrenia and indicated for the patients who pose a serious psychotic disorders who are hospitalized in a threat to themselves or others, those who are psychiatry clinic. disorganized to the extent of not to being able to The steps to be taken to treat patients look after themselves or who are experiencing diagnosed with schizophrenia and psychotic delusions/hallucinations. Other possible disorder in an optimal way during the time they indications include the presence of general stay in a hospital and then to reintegrate them medical or psychiatric problems that may render into the society have been documented by the outpatient treatment unsafe or ineffective1. Some Hospital Setting Expert Committee (HSEC) schizophrenia patients in the maintenance phase consisting of 19 psychiatrists from Europe may be hospitalized in a psychiatry clinic for the including the first author of this paper (the list of purpose of improving their psychosocial doctors comprising this team is in Annex-1), who functioning and for rehabilitation. are specialists in the acute management of The major aim of acute hospitalization is to schizophrenia patients. The committee held a facilitate rapid reversal of acute symptoms by meeting in May 2012 to discuss some specific creating a safe and stress-free treatment subjects regarding the treatment of such patients environment. For this reason, the hospital setting in a hospital setting. It was found at the end of should be arranged to fulfill this aim2. A short- this meeting that specific recommendations term hospitalization has been shown to be as regarding the management of these patients in a effective as a long-term hospitalization for acute hospital setting were insufficient in the existing patients whose psychotic symptoms can be guidelines. Therefore, it was decided to develop a improved rapidly by way of antipsychotic treatment guideline that can be used for these treatment2,3. In studies carried out in the United patients in a hospital setting. The first version of States of America, the efficiency of the shortest the algorithm was prepared in a way to focus on hospitalization time, 11 days, has been compared the acute care contained in the current to that of 60 days of hospitalization3. In a study guidelines. The topics in the algorithm were Klinik Psikofarmakoloji Bülteni, Cilt: 24, Sayı: 3, 2014 / Bulletin of Clinical Psychopharmacology, Vol: 24, N.: 3, 2014 - www.psikofarmakoloji.org 277 Treatment guidelines for patients with schizophrenia or psychotic disorder who are hospitalized in a psychiatry clinic assessment of the patient, application, hospital through the time after their leaving the management of agitation and aggression, hospital are as follows: pharmaceutical treatment, non-pharmaceutical (1) Assessing the acute psychotic episode treatment and stabilization. The draft guideline (2) Defining treatment targets for inpatient prepared in March was reviewed by this
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