Реорганизация психиатрической службы и антипсихотическая терапия больных шизофренического спектра

Abstract

The article discusses the trends in the use of antipsychotic drugs in the treatment of patients with schizophrenic spectrum disorders (RSHS) in the context of the reorganization of the psychiatric service on the example of Moscow. The reform of the psychiatric service (2012-2020) has radically changed the structure of psychiatric care, the system for evaluating its effectiveness and the economic basis. While the number of inpatient beds decreased by more than 3 times, the number of places in day hospitals increased by more than 2 times, the number of visits to a psychiatrist in the outpatient network increased by 2.5 times during the year. During the period under review, the number of repeated hospitalizations of patients with RS in psychiatric hospitals has also significantly decreased. At the same time, stable indicators of the incidence of RS during the considered period of time remain. Simultaneously with the reform of the psychiatric service, there was an increase in the consumption of antipsychotics from 7.6 million Defined Daily Dose (DDD) in 2013 to 12.3 million DDD in 2021, including conventional (KA) and atypical antipsychotics (AA) from 17% to 30% with an outstripping increase in the use of prolonged injectable antipsychotics (primarily AA). If in 2013-2016 AA of prolonged action made up an insignificant part of the total array of prolonged drugs (5-9%), then there was a consistent increase in their use. In 2021 they accounted for 36% of the total volume of prolonged-acting drugs (an increase of 400%), with a general increase in the use of prolonged forms by about 3 times. There was a sevenfold increase in the proportion of injectable forms from the total volume of AA – from 3% (2016) to 23%, and a twofold overall increase in the volume of AA use from 2.5 million DDD (2013) to 5.8 million DDD (2021). It is stated that there has been a stabilization of the system of providing psychiatric care to patients with RSHS with a shift of emphasis to the outpatient link and the widespread introduction of prolonged AA. To the greatest extent, these trends are found in the increasing use of risperidone-const and prolonged forms of paliperidone. It is concluded that the psychiatric service is on the threshold of a new stage of development, which represents a way of personalizing psychiatric care based on an individual approach to the patient.