Another reality and the ninth ...

Another reality and the ninth feature of the present phase of pharmacotherapy is the massive polypharmacy, ie widespread use of various combinations of psychotropic drugs. According to our data, up to 80-90% of patients in both inpatient and outpatient receive two or more psychotropic drugs. Unfortunately, combination therapy is often appointed without sufficient grounds and the possibility of drug interactions underestimate. So, about a fifth of patients with schizophrenia outpatients, along with prolonged neuroleptic additionally receives conventional antipsychotics or atypical antipsychotics recently inside, which can completely neutralize the positive features of their clinical activities. In addition, the likelihood of side effects increases in direct proportion to the number of prescribed drugs. Now it is proved that the majority of psychotropic drugs metabolized by cytochrome P450 liver. As can be seen from Table 2, are potent inhibitors of the enzyme, in particular, selective serotonin reuptake inhibitors. Due to reduction of drug metabolism during their half-life may increase by 4 times or more, which leads to the development of toxic effects. Therefore, a joint appointment means metabolized by one family of cytochrome P450 isoenzymes, should be avoided. Questions of therapeutic resistance is closely related to the problem prediction effectiveness of therapy. Unfortunately, individual clinical effectiveness of pharmacotherapy forecast exchange rate still remains quite uncertain and it seems that may be presented as a tenth feature. For illustration, we can bring the results of our special study on prediktsii therapeutic effect using multivariate analysis of variance, which are shaped form shown in Figure 1. Fig. 1. Influence of clinical and biological factors on the therapeutic effect can be seen that all clinical factors (nosology, particularly manifestation and course of illness, patterns sindromoobrazovaniya, psychopathological symptoms, shades, premorbid characteristics, including hereditary and genetic factors and pathological changes in soil) are able to give a satisfactory forecast of psychopharmacological only 40-50% of cases. Various endogenous (physiological, endocrine, biochemical, pharmacokinetic, etc.) and external (social, stress, economic and other) factors can improve forecast accuracy to 70-80%. Nevertheless, from 20 to 30% of the total diversity of performance evaluations for treatment falls on the unknown or unrecorded factors. These data indicate that nearly one third of patients despite an adequate selection of treatment in accordance with an accurate clinical skills and other factors, the first course of pharmacotherapy can be effective. Another frequent cause for relapse and promotes therapeutic resistance is low or non-compliance of patients with the recommended treatment regimen.