Análise do perfil de prescrição farmacológica e de sua correlação com aspectos sociodemográficos, clínicos, cognitivos e funcionais de uma amostra de pacientes brasileiros com Esquizofrenia

Abstract

Introduction: Schizophrenia is a serious and disabling mental illness. Primary cognitive impairment is a major determinant of such disability and became the focus of research in the last 25 years. Antipsychotic medication is effective in the treatment of psychotic crisis, but currently there is no evidence of enhancement of cognitive symptoms. Treatment protocols are progressively integrating pharmacological recommendations aiming at avoiding cognitive iatrogenesis. Many are the evidences of secondary cognitive impairment in Schizophrenia due to high doses of dopaminergic and muscarinic antagonists. Objectives: To describe the pharmacological treatment profile of community-dwelling patients with Schizophrenia living in Brazil, and correlate it with sociodemographic, clinical, symptomatic, and cognitive and everyday functioning performance. The main hypothesis is that iatrogenic cognitive impairment may be masked by a floor-effect, related to the low educational status of our country. Methods: We assessed 144 patients in this research, from 4 community-dwelling treatment facilities. Sociodemographic and clinical data were collected through a semi-structured interview. Symptoms were assessed by the PANSS. Patients in antipsychotics monotherapy were divided in “typical” and “atypical” groups. Antipsychotic doses were converted to chlorpromazine equivalents, and anticholinergic doses to benztropine equivalents. Cognitive performance was assessed by the BACS, functional capacity by the UPSA, and real-world functioning by PSP. Results: Our sample had 50,7% in typical antipsychotic monotherapy, 34% of atypical antipsychotic monotherapy, 6,3% using both antipsychotic groups, and 9% were on clozapine regimen. The mean antipsychotic dose in patients on monotherapy regimen was 420,1mg/day of chlorpromazine-equivalent. We found 68,9% patients taking at least one anticholinergic medication, mainly biperiden, among those in antipsychotic monotherapy, with a mean dose of 3mg/day of benztropine-equivalent. Atypical antipsychotics are used more frequently in people with higher educational status, lower age of disease onset, lower duration of disease and from a tertiary treatment facility, in lower doses, and are less likely to be combined with anticholinergic medication. Only secondary and tertiary treatment facilities had patients taking clozapine. In our sample with low educational status, antipsychotic pharmacological group and antipsychotic dose were not related to independent iatrogenic cognitive impairment, whereas anticholinergic load presented only a statistical tendency to impair Attention and Speed of Processing. Antipsychotic pharmacological group and anticholinergic load were not related to independent iatrogenic functional impairment, whereas antipsychotic dose presented only a tendency to impair Transportation Skills and Household Management in Functional Capacity. Conclusions: The pharmacological treatment profile of community-dwelling patients with Schizophrenia living in Brazil should be improved, as well as the current official recommendations. Nonetheless, there are no clear evidences of an iatrogenic effect on cognitive and functional performances, what possibly is due to a floor-effect mediated by the low educational status of our population.