Primjena kvetiapina u neodobrenoj indikaciji za liječenje posttraumatskog stresnog poremećaja

Abstract

Cilj istraživanja: Cilj ovog specijalističkog rada je dati sustavan prikaz literaturnih podataka o mogudim koristima i rizicima neodobrene primjene kvetiapina u liječenju posttraumatskog stresnog poremedaja. Pregledom dosadašnjih istraživanja i mišljenja stručnjaka pokušava se pronadi kakva je uloga i učinkovitosti kvetiapina u liječenju posttraumatskog stresnog poremedaja. Materijali i metode: Pri izradi i oblikovanju ovog rada napravljen je sustavni pregled literature iz područja posttraumatskog stresnog poremedaja, farmakoterapije PTSP-a, antipsihotika druge generacije. Korišteni su sažetak opisa svojstava lijeka kvetiapina, stručna medicinska literatura, pretraga baza podataka PubMed za ključne riječi: posttraumatski stresni poremedaj, antipsihotici, kvetiapin, farmakoterapija. Na temelju pojedinih radova, saznanja o provedenim kliničkim ispitivanjima, tijeku i prirodi poremedaja izvedeni su zaključci i vlastita razmatranja o proučavanoj tematici. Zaključci: Prilikom liječenja PTSP-a oboljelima se propisuju lijekovi koji ciljano djeluju na simptome bolesti. U literaturi se posebno ističe da su jedan od najuznemirujudih simptoma bolesti upravo oni koji se javljaju nodu, odnosno nodne more i insomnija. Iako ne postoje dvostruko slijepa, prospektivna, randomizirana istraživanja koja bi pratila učinak kvetiapina u liječenju PTSP-a, iz manjih kliničkih studija i prikaza slučaja uočena je korist od ovog lijeka. Mnogi autori se slažu da za normalno funkcioniranje svake oboljele osobe je bitno da ima nodni odmor i kvalitetan san. Za vrijeme spavanja tijelo ima priliku za oporavak od dnevnog i nakupljenog stresa, kao i trauma. Kod oboljelih od PTSP-a prilika za oporavak tijekom sna je ugrožena što oporavak ovakvim osobama čini težim. Nadalje, simptomi insomnije i nodnih mora često se nazivaju i jednim od glavnih, čak i jednim od ciljanih simptoma za djelovanje o kojem ovisi daljnji razvoj bolesti. Prilikom pregledavanja literature pokazalo se da je kvetiapin upravo učinkovit za liječenje insomnije i smanjenu pojavnost nodnih mora. Vedina literaturnih podataka ukazuje da na bolju učinkovitost kvetiapina kad se dodaje na ved postojedu terapiju. Svakako je potrebno napraviti dodatna klinička istraživanja s naglaskom na randomizirana, dvostruko slijepa, usporedna ili placebom kontrolirana kako bi se jasno potvrdio učinak i mjesto kvetiapina u liječenju oboljelih od PTSP-a.Objectives: The aim of this specialist study is to give systematic overview of literature about possible benefits and risks from off-label use of quetiapine for treating posttraumatic stress disorder. While searching the literature and expert's opinions there is an ambition to find the role and efficacy of quetiapine in posttraumatic stress disorder. Materials and Methods: The development and creating of this paper was done in a systematic and retrospective review of literature in the field of posttraumatic stress disorder, pharmacotherapy for PTSD, second generation antipsychotics. Summary of Products Characteristic of Quetiapine, medical literature was used during the creation of this paper, and also search through database Pubmed for key words: posttraumatic stress disorder, antipsychotics, quetiapine and pharmacotherapy. At the end conclusions and my own thoughts were made about researched theme based on findings from clinical trials, expert's opinions and articles and based on specific features and nature of posttraumatic stress disorder. Conclusion: While treating the PTSD prescribed pharmacotherapy is chosen specifically to treat the main symptoms of disorder. In literature it can be found that one of the most disturbing symptoms are those that occur during the night, to be specific nightmares and insomnia. At the moment, double blinded, prospective, randomized clinical trials that had shown the efficacy of quetiapine for treating PTSD are not conducted but from smaller clinical trials and case reports the efficacy of this drug can be seen. Many researchers agree with the fact that for conducting normal life everyone should have good night rest and good quality of sleep. During the sleep body has an opportunity to rest from daily and accumulated stress and also from trauma. Patients with PTSD due to problems with insomnia and nightmares have less chance to rest during the sleep. This has a huge impact on patient's recovery. Furthermore, insomnia and nightmares are often called one of the most important symptoms to treat while prescribing drugs to patients with PTSD. During the literature research it was noted that quetiapine had shown the efficacy for treating the insomnia and had decreased the incidence of nightmares. The most data from literature indicate that quetiapine has better efficacy when it is prescribed in combination with other psychopharmacotherapy. For establishing the exact role and efficacy of quetiapine for treating PTSD additional double blinded, randomized, placebo-controlled or comparative clinical trials should be conducted