{"id":61410,"date":"2024-09-30T10:06:58","date_gmt":"2024-09-30T10:06:58","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=61410"},"modified":"2024-10-09T19:03:12","modified_gmt":"2024-10-09T19:03:12","slug":"pharmacotherapy-effectiveness-in-treating-mental-disorders-in-kosovos-specialized-institutions","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol17no3\/pharmacotherapy-effectiveness-in-treating-mental-disorders-in-kosovos-specialized-institutions\/","title":{"rendered":"Pharmacotherapy Effectiveness in Treating Mental Disorders in Kosovo’s Specialized Institutions"},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

Globally,\napproximately 12% of the population is affected by mental and behavioral\ndisorders, yet only a small portion of these individuals receive appropriate\ntreatment. This category includes a range of conditions such as depressive disorders,\nschizophrenia, epilepsy, dementia, post-traumatic stress disorder,\nobsessive-compulsive disorders, panic disorders, and primary insomnia.<\/p>\n\n\n\n

In many developed\nregions, a limited number of individuals with mental disorders actively seek\nassistance from healthcare providers. Conversely, in developing nations,\nhealthcare systems often fall short in delivering essential mental health\nservices. The World Health Organization (WHO) suggests that the most effective\ntreatment for mental disorders is a combination of psychosocial and\npharmacological therapies.<\/p>\n\n\n\n

Studies utilizing\nvarious methodologies have revealed high rates of drug interactions, with\nsevere consequences reported in 2.2% to 30% of hospitalized patients and 9.2%\nto 70.3% of patients in community settings. These findings underscore the\nimportance of assessing prescription practices, especially in mental health\nfacilities in Kosovo.<\/p>\n\n\n\n

While psychotropic\ndrugs have proven highly effective in improving mental health outcomes, their\nassociated side effects pose significant health, social, and economic\nchallenges. Unlike in other countries where treatment is overseen by\nspecialized centers, the absence of such infrastructure in Kosovo calls for\ncontinuous research to monitor and improve current practices.<\/p>\n\n\n\n

Study Objective<\/strong><\/p>\n\n\n\n

The purpose of this study is to\nassess the treatment strategies employed for patients with mental health\ndisorders in specialized centers across Kosovo. The evaluation spans from\nJanuary to December 2023, including all centers dedicated to the treatment of\nvarious mental health conditions.<\/p>\n\n\n\n

Materials and Methods<\/strong><\/p>\n\n\n\n

This study follows\nthe guidelines set by international organizations specializing in mental health\nresearch, adhering to recommendations outlined in global documents that\ndescribe methods for monitoring drug usage in healthcare settings. These\nguidelines provide straightforward approaches for analyzing and evaluating the\nquality of drug prescriptions and distribution, along with offering indicators\nfor drug use in various developmental contexts. The outcomes of these\nindicators are crucial for enhancing oversight and management of mental health\nprograms.<\/p>\n\n\n\n

Data collection\nwas conducted using specialized questionnaires that gathered information on\npatients’ age, gender, diagnosis, and treatment at specialized mental health\ncenters across Kosovo. The data were sourced from patient records within these\ninstitutions. In each region, 50 patients were selected and analyzed using\nprobabilistic sampling methods, resulting in a total dataset of 400 patients\nfrom all mental health centers in Kosovo.<\/p>\n\n\n\n

Demographic\ncharacteristics were assessed by examining the gender distribution and average\nage of patients at the included centers. The mental health disorders were\ncategorized according to the International Classification of Diseases, 10th\nEdition (ICD-10).<\/p>\n\n\n\n

The analysis of\npharmacological treatment involved evaluating the strategies employed in\ntreating mental health disorders at these specialized centers. Medication\nadministration methods were categorized into two primary groups: \u201cOral\nAdministration\u201d for medications taken orally and \u201cParenteral Administration\u201d\nfor those administered via injections. Additionally, the study reviewed the use\nof medications listed in essential medicines lists.<\/p>\n\n\n\n

To assess\ntreatment effectiveness in greater detail, the study analyzed the treatment\nstrategies for mental disorders, focusing on stages and levels of therapy. For\nschizophrenia, patients were categorized based on the treatments used: atypical\nantipsychotics (excluding clozapine) were placed in the first-line treatment\nstages (1, 2, and 3). Patients treated with high-potency conventional\nantipsychotics were grouped into the second stage of therapy, representing\nsecond-line treatment.<\/p>\n\n\n\n

In the fourth stage, patients receiving conventional antipsychotics were included, while those treated with Clozapine were classified in the fifth stage. Patients treated with Clozapine in combination with other agents (such as conventional antipsychotics, atypical antipsychotics, or antidepressants) were placed in subgroup 5a. Cases involving combined therapy with different antipsychotics were categorized into subgroup 5b, representing third-line treatment.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Stage of  therapy<\/p>\n<\/td>\n

\n

drag<\/p>\n<\/td>\n

\n

order of  therapy<\/p>\n<\/td>\n<\/tr>\n

\n

1<\/p>\n<\/td>\n

\n

AP-atypical<\/p>\n

(Olanzapina, or<\/p>\n

Quetiapina, or<\/p>\n

Risperidoni)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

AP-atypical<\/p>\n

(if one does not work, the other is used)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n<\/tr>\n

\n

3<\/p>\n<\/td>\n

\n

AP-atipik\u00eb<\/p>\n

(If the second does not work, the third is used)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n<\/tr>\n

\n

4<\/p>\n<\/td>\n

\n

AP-typical<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n<\/tr>\n

\n

5<\/p>\n<\/td>\n

\n

Clozapinum (C)<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n<\/tr>\n

\n

5a<\/p>\n<\/td>\n

\n

C + potentiating drugs (AP-typical , ose NO-atypical, AD, etj.)<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n<\/tr>\n

\n

5b<\/p>\n<\/td>\n

\n

Combined therapy (AP-typical+ AP-atypical)<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

For the treatment\nof depression, we have implemented a systematic approach to categorize\ntherapeutic strategies.<\/p>\n\n\n\n

First Stage<\/strong><\/p>\n\n\n\n

This stage includes patients receiving first-line therapy with selective serotonin reuptake inhibitors (SSRIs) as monotherapy.<\/p>\n\n\n\n

Second and Third Stages<\/strong><\/p>\n\n\n\n

These stages involve patients undergoing treatment with SSRIs combined with augmentation strategies. In the second stage, Lithium (Li) is used as a first-line enhancer, while in the third stage, Buspirone is employed as a second-line enhancer. Benzodiazepines (BZ) are also included in this stage as second-line enhancers.<\/p>\n\n\n\n

Fourth Stage<\/strong><\/p>\n\n\n\n

Patients treated with tricyclic antidepressants (TCAs) as monotherapy are classified into second-line therapy in this stage.<\/p>\n\n\n\n

Fifth Stage<\/strong><\/p>\n\n\n\n

This stage encompasses cases of combined therapy, where multiple drug combinations are utilized to enhance therapeutic outcomes.<\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

Stage of  therapy<\/p>\n<\/td>\n

\n

drag<\/p>\n<\/td>\n

\n

order of  therapy<\/p>\n<\/td>\n<\/tr>\n

\n

1<\/p>\n<\/td>\n

\n

Serotonin reuptake inhibitors (SSRI)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

SSRI+ Effect boosters<\/p>\n

(As enhancers: Li, Buspirone)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n<\/tr>\n

\n

3<\/p>\n<\/td>\n

\n

SSRI + Effect Enhancers<\/p>\n

(Benzodiazepines – BZ)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n<\/tr>\n

\n

4<\/p>\n<\/td>\n

\n

Tricyclic antidepressants (TCAs) (monotherapy)<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n<\/tr>\n

\n

5<\/p>\n<\/td>\n

\n

Combined therapy<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

For generalized\nanxiety disorders, we have organized treatments based on the stage and sequence\nof therapy:<\/p>\n\n\n\n

First Stage<\/strong><\/p>\n\n\n\n

This stage includes patients undergoing first-line therapy with benzodiazepines (BZ) as monotherapy.<\/p>\n\n\n\n

Second Stage<\/strong><\/p>\n\n\n\n

Patients receiving second-line therapy with Buspirone or antidepressants (AD) are included in this stage.<\/p>\n\n\n\n

Third Stage<\/strong><\/p>\n\n\n\n

This stage comprises patients treated with third-line therapies, including Trazodone, Fluoxetine, Imipramine, or Propranolol.<\/p>\n\n\n\n

For the treatment\nof panic-type neurotic disorders, we have implemented a structured approach\nthat categorizes therapy by stage and sequence:<\/p>\n\n\n\n

First Stage<\/strong><\/p>\n\n\n\n

This initial stage represents the highest level of therapy and includes patients treated with benzodiazepines (BZ), tricyclic antidepressants (TCA), or selective serotonin reuptake inhibitors (SSRI).<\/p>\n\n\n\n

Second and Third Stages<\/strong><\/p>\n\n\n\n

If the initial medications are insufficient, patients advance to these stages where alternative treatments are utilized to achieve the desired outcomes.<\/p>\n\n\n\n

Fourth Stage<\/strong><\/p>\n\n\n\n

When conventional treatments fail, combined therapies (e.g., BZ + TCA, BZ + SSRI, or TCA + SSRI) are employed. This stage corresponds to second-level therapy.<\/p>\n\n\n\n

Fifth Stage<\/strong><\/p>\n\n\n\n

If the response to previous strategies remains inadequate, therapy is intensified with Valproic Acid or Clonidine, marking the third-level therapy in the treatment sequence.<\/p>\n\n\n\n

To evaluate the stages and sequence of therapy for specific\npsychiatric disorders, we have adhered to the guidelines established by the\nAmerican Psychiatric Association. These guidelines focus on assessing the\nefficacy and side effect profiles of various therapeutic options, helping to\ndetermine the most appropriate level of treatment for different categories of\npsychiatric conditions. In our analysis, we employed statistical measures such\nas the structural index, arithmetic mean, and standard deviation to provide a\ncomprehensive and precise summary of the data. The findings are presented in\nboth tabular and graphical formats to enhance interpretation and visualization.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

In this study, we examined a sample of 400 patients with psychiatric conditions who received treatment at seven different Mental Health Centers across Kosovo. Out of these, 220 (55%) were male. The gender distribution of patients was relatively consistent across all centers (Chi-Test = 37, p > 0.30). However, at the Mental Health Centers in Gjilan and Prizren, there was a higher percentage of female patients compared to male patients, with 57.5% in Gjilan and 54.2% in Prizren. In contrast, the percentage of male and female patients in Mitrovica was equal (Tab. 1).<\/p>\n\n\n\n

Table 1: Special mental health centers in Kosovo <\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

Indikatori<\/strong><\/p>\n<\/td>\n

\n

Special mental health centers in Kosovo<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Ferizaj<\/strong><\/p>\n<\/td>\n

\n

Gjakova<\/strong><\/p>\n<\/td>\n

\n

Gjilan<\/strong><\/p>\n<\/td>\n

\n

Mitrovica<\/strong><\/p>\n<\/td>\n

\n

Peja<\/strong><\/p>\n<\/td>\n

\n

Pristina<\/strong><\/p>\n<\/td>\n

\n

Prizren<\/strong><\/p>\n<\/td>\n

\n

Total<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Number of Patients<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

60<\/p>\n<\/td>\n

\n

60<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

40<\/p>\n<\/td>\n

\n

90<\/p>\n<\/td>\n

\n

400<\/p>\n<\/td>\n<\/tr>\n

\n

Gender. * \u2013 nr. (%)<\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

M<\/strong><\/p>\n<\/td>\n

\n

17 (56.7)<\/p>\n<\/td>\n

\n

19 (63.3)<\/p>\n<\/td>\n

\n

13 (44.8)<\/p>\n<\/td>\n

\n

15 (50.0)<\/p>\n<\/td>\n

\n

18 (60.0)<\/p>\n<\/td>\n

\n

22 (73.3)<\/p>\n<\/td>\n

\n

14 (46.7)<\/p>\n<\/td>\n

\n

118 (56.5)<\/p>\n<\/td>\n<\/tr>\n

\n

Average age ** \u2013 Mean (StdDev)<\/strong><\/p>\n<\/td>\n

\n

37.24 (11.8)<\/p>\n<\/td>\n

\n

33.4 (13.5)<\/p>\n<\/td>\n

\n

43.0 (9.9)<\/p>\n<\/td>\n

\n

39.0 (13.0)<\/p>\n<\/td>\n

\n

38.6 (11.3)<\/p>\n<\/td>\n

\n

37.0 (15.6)<\/p>\n<\/td>\n

\n

33.2 (12.8)<\/p>\n<\/td>\n

\n

36.0 (13.9)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

The study assessed 400 individuals with psychiatric\ndisorders treated at seven Mental Health Centers throughout Kosovo. Among them,\n210 (50%) were male. The gender distribution was quite uniform across all\ncenters (*Chi-Test = 35, p > 0.24). Notably, the centers in Gjilan and\nPrizren had a higher proportion of female patients compared to male patients,\nwith 54.7% in Gjilan and 51.0% in Prizren. Conversely, in Mitrovica, the\ndistribution of male and female patients was equal (Tab. 1).<\/p>\n\n\n\n

The average age of the participants was 38 years (38.0 \u00b1\n11.7). The age distribution was comparable across the centers, with no\nsignificant differences (F-test = 1.54, p > 0.14). The youngest average age\nwas observed in Ferizaj (34.6 \u00b1 10.6 years), whereas the oldest average age was\nin Gjilan (41.9 \u00b1 9.9 years) (Tab. 1).<\/p>\n\n\n\n

Table 2: Structure of Patients Included in the Study by Diagnosis (n=400)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Disease Group Number<\/strong><\/p>\n<\/td>\n

\n

Code (ICD-10) Disease<\/strong><\/p>\n<\/td>\n

 <\/td>\n\n

Nr.<\/strong><\/p>\n<\/td>\n

\n

(%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

F20 \u2013 F29<\/p>\n

Schizophrenia and Schizotypal Disorders<\/p>\n<\/td>\n

\n

F20<\/p>\n<\/td>\n

\n

Schizophrenia<\/p>\n<\/td>\n

\n

137<\/p>\n<\/td>\n

\n

(65.6)<\/p>\n<\/td>\n<\/tr>\n

\n

F21<\/p>\n<\/td>\n

\n

Disordo schizotypicus<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n

\n

(1.0)<\/p>\n<\/td>\n<\/tr>\n

\n

F23<\/p>\n<\/td>\n

\n

Psychoses acutae et transitivae<\/p>\n<\/td>\n

\n

10<\/p>\n<\/td>\n

\n

(3.8)<\/p>\n<\/td>\n<\/tr>\n

\n

F23.1<\/p>\n<\/td>\n

\n

Psychoses acutae et transitivae<\/p>\n<\/td>\n

\n

15<\/p>\n<\/td>\n

\n

(2.9)<\/p>\n<\/td>\n<\/tr>\n

\n

F25<\/p>\n<\/td>\n

\n

Psychoses schizoaffectivae<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n

\n

(1.0)<\/p>\n<\/td>\n<\/tr>\n

\n

Subtotal<\/p>\n<\/td>\n

 <\/td>\n\n

157<\/p>\n<\/td>\n

\n

(74.2)<\/p>\n<\/td>\n<\/tr>\n

\n

F30 – F39<\/p>\n

Affective Disorders<\/p>\n<\/td>\n

\n

F32.2\/33.2<\/p>\n<\/td>\n

\n

Depressio non psychoticum\/Depressio recidiva non psychotica<\/p>\n<\/td>\n

\n

14<\/p>\n<\/td>\n

\n

(6.7)<\/p>\n<\/td>\n<\/tr>\n

\n

Subtotal<\/p>\n<\/td>\n

 <\/td>\n\n

14<\/p>\n<\/td>\n

\n

(6.7)<\/p>\n<\/td>\n<\/tr>\n

\n

F40 – F48<\/p>\n

Neurotic, Stress-Related, and Somatic Disorders<\/p>\n<\/td>\n

\n

F40<\/p>\n<\/td>\n

\n

Disordines anxiosi phobici<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

(0.5)<\/p>\n<\/td>\n<\/tr>\n

\n

F41<\/p>\n<\/td>\n

\n

Disordines anxiosi alii<\/p>\n<\/td>\n

\n

20<\/p>\n<\/td>\n

\n

(4.8)<\/p>\n<\/td>\n<\/tr>\n

\n

F43.1<\/p>\n<\/td>\n

\n

Disordo posttraumaticus stresogenes<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n

\n

(1.0)<\/p>\n<\/td>\n<\/tr>\n

\n

F44<\/p>\n<\/td>\n

\n

Disordines dissociativi (conversiones)<\/p>\n<\/td>\n

\n

9<\/p>\n<\/td>\n

\n

(1.9)<\/p>\n<\/td>\n<\/tr>\n

\n

F45<\/p>\n<\/td>\n

\n

Disordines somatoformes<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n

\n

(1.0)<\/p>\n<\/td>\n<\/tr>\n

\n

F48<\/p>\n<\/td>\n

\n

Disordines neurotici alii<\/p>\n<\/td>\n

\n

5<\/p>\n<\/td>\n

\n

(1.4)<\/p>\n<\/td>\n<\/tr>\n

\n

Subtotal<\/p>\n<\/td>\n

 <\/td>\n\n

36<\/p>\n<\/td>\n

\n

(10.5)<\/p>\n<\/td>\n<\/tr>\n

\n

F51<\/p>\n

Disordines somni non organici<\/p>\n<\/td>\n

\n

F51<\/p>\n<\/td>\n

\n

Disordines somni non organici<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

(0.5)<\/p>\n<\/td>\n<\/tr>\n

\n

Subtotal<\/p>\n<\/td>\n

 <\/td>\n\n

1<\/p>\n<\/td>\n

\n

(0.5)<\/p>\n<\/td>\n<\/tr>\n

\n

F70 – F79<\/p>\n

Intellectual Disability<\/p>\n<\/td>\n

\n

F70<\/p>\n<\/td>\n

\n

Retardatio mentalis levis<\/p>\n<\/td>\n

\n

10<\/p>\n<\/td>\n

\n

(4.8)<\/p>\n<\/td>\n<\/tr>\n

\n

F71<\/p>\n<\/td>\n

\n

Retardatio mentalis moderata<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

(0.5)<\/p>\n<\/td>\n<\/tr>\n

\n

Subtotal<\/p>\n<\/td>\n

 <\/td>\n\n

19<\/p>\n<\/td>\n

\n

(5.3)<\/p>\n<\/td>\n<\/tr>\n

\n

F90 – F99<\/p>\n

Behavioral Disorders and Emotional Disorders<\/p>\n<\/td>\n

\n

F92<\/p>\n<\/td>\n

\n

Disordines morum et emotionum mixti<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

(1.9)<\/p>\n<\/td>\n<\/tr>\n

\n

Subtotal<\/p>\n<\/td>\n

 <\/td>\n\n

4<\/p>\n<\/td>\n

\n

(1.9)<\/p>\n<\/td>\n<\/tr>\n

\n

G40<\/p>\n

Epilepsi<\/p>\n<\/td>\n

\n

G40<\/p>\n<\/td>\n

\n

Epilepsia<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n

\n

(1.0)<\/p>\n<\/td>\n<\/tr>\n

\n

Subtotal<\/p>\n<\/td>\n

 <\/td>\n\n

3<\/p>\n<\/td>\n

\n

(1.0)<\/p>\n<\/td>\n<\/tr>\n

\n

Total<\/p>\n<\/td>\n

 <\/td>\n <\/td>\n\n

400<\/p>\n<\/td>\n

\n

(100.0)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

The\nanalysis of patient morbidity in this study revealed that the majority of\nindividuals (296 out of 400, or 74%) were diagnosed with schizophrenia and related\ndisorders, categorized under F20-F29 according to the International\nClassification of Diseases, 10th Edition. Within this group, 263 patients\n(65.8%) were identified with schizophrenia. Neurotic disorders, including\nstress and somatoform disorders (F40-F48), affected 42 patients (10.5%).\nAdditionally, 27 patients (6.7%) were diagnosed with affective disorders\npresenting non-psychotic depressive symptoms and recurrent episodes. Mental\nretardation was identified in 21 patients (5.3%), with the majority (20\npatients) classified as having mild retardation. Behavioral and emotional\ndisorders were observed in a much smaller cohort, representing 2% of the total\n(8 out of 400) (Tab. 2).<\/p>\n\n\n\n

Table 3: Pharmacotherapeutic Characteristics of Patients with Mental Disorders Treated at Different Centers<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Indicator<\/p>\n<\/td>\n

\n

Specialized Mental Health Centers in the Republic of Kosovo<\/p>\n<\/td>\n<\/tr>\n

\n

Ferizaj<\/p>\n<\/td>\n

\n

Gjakova<\/p>\n<\/td>\n

\n

Gjilan<\/p>\n<\/td>\n

\n

Mitrovica<\/p>\n<\/td>\n

\n

Peja<\/p>\n<\/td>\n

\n

Pristina<\/p>\n<\/td>\n

\n

Prizren<\/p>\n<\/td>\n

\n

Total<\/p>\n<\/td>\n<\/tr>\n

\n

Number of Patients<\/strong><\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

60<\/p>\n<\/td>\n

\n

60<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

40<\/p>\n<\/td>\n

\n

90<\/p>\n<\/td>\n

\n

400<\/p>\n<\/td>\n<\/tr>\n

\n

Method of Drug Administration \u2020 (%)<\/p>\n<\/td>\n

 <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\n

P.O.<\/p>\n<\/td>\n

\n

(68.5)<\/p>\n<\/td>\n

\n

(89.6)<\/p>\n<\/td>\n

\n

(63.3)<\/p>\n<\/td>\n

\n

(91.9)<\/p>\n<\/td>\n

\n

(56.0)<\/p>\n<\/td>\n

\n

(67.5)<\/p>\n<\/td>\n

\n

(86.4)<\/p>\n<\/td>\n

\n

(86.4)<\/p>\n<\/td>\n<\/tr>\n

\n

Parenteral<\/p>\n<\/td>\n

\n

(49.7)<\/p>\n<\/td>\n

\n

(17.5)<\/p>\n<\/td>\n

\n

(26.9)<\/p>\n<\/td>\n

\n

(11.1)<\/p>\n<\/td>\n

\n

(39.0)<\/p>\n<\/td>\n

\n

(25.5)<\/p>\n<\/td>\n

\n

(16.6)<\/p>\n<\/td>\n

\n

(15.6)<\/p>\n<\/td>\n<\/tr>\n

\n

Medication Description (%)<\/p>\n<\/td>\n

 <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Essential Medication (%)<\/p>\n<\/td>\n

\n

(33.4)<\/p>\n<\/td>\n

\n

(45.8)<\/p>\n<\/td>\n

\n

(54.0)<\/p>\n<\/td>\n

\n

(44.0)<\/p>\n<\/td>\n

\n

(36.8)<\/p>\n<\/td>\n

\n

(55.4)<\/p>\n<\/td>\n

\n

(34.9)<\/p>\n<\/td>\n

\n

(36.9)<\/p>\n<\/td>\n<\/tr>\n

\n
Drug Group (%)<\/h5>\n<\/td>\n
 <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n <\/td>\n\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Antidepressants (AD)<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(6.0)<\/p>\n<\/td>\n

\n

(3.3)<\/p>\n<\/td>\n

\n

(7.1)<\/p>\n<\/td>\n

\n

(10.7)<\/p>\n<\/td>\n

\n

(4.4)<\/p>\n<\/td>\n

\n

(14.3)<\/p>\n<\/td>\n

\n

(5.9)<\/p>\n<\/td>\n<\/tr>\n

\n
Anxiolytics\/Hypnotics (AL\/H)<\/h5>\n<\/td>\n
\n

(0.9)<\/p>\n<\/td>\n

\n

(17.9)<\/p>\n<\/td>\n

\n

(8.2)<\/p>\n<\/td>\n

\n

(24.2)<\/p>\n<\/td>\n

\n

(11.9)<\/p>\n<\/td>\n

\n

(16.2)<\/p>\n<\/td>\n

\n

(22.4<\/p>\n<\/td>\n

\n

(13.8)<\/p>\n<\/td>\n<\/tr>\n

\n

Antipsychotics (AP)<\/p>\n<\/td>\n

\n

(61.7)<\/p>\n<\/td>\n

\n

(56.0)<\/p>\n<\/td>\n

\n

(57.4)<\/p>\n<\/td>\n

\n

(40.4)<\/p>\n<\/td>\n

\n

(42.9)<\/p>\n<\/td>\n

\n

(66.2)<\/p>\n<\/td>\n

\n

(42.9)<\/p>\n<\/td>\n

\n

(53.2)<\/p>\n<\/td>\n<\/tr>\n

\n

Anticonvulsants (AC)<\/strong><\/p>\n<\/td>\n

\n

(8.9)<\/p>\n<\/td>\n

\n

(3.6)<\/p>\n<\/td>\n

\n

(1.6)<\/p>\n<\/td>\n

\n

(2.0)<\/p>\n<\/td>\n

\n

(1.2)<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(3.0)<\/p>\n<\/td>\n<\/tr>\n

\n

Analgesics (A)<\/strong><\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(3.3)<\/p>\n<\/td>\n

\n

(2.0)<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(2.0)<\/p>\n<\/td>\n

\n

(0.9)<\/p>\n<\/td>\n<\/tr>\n

\n

Anticholinergics (Anti-Ch)<\/p>\n<\/td>\n

\n

(26.5)<\/p>\n<\/td>\n

\n

(14.3)<\/p>\n<\/td>\n

\n

(18.0)<\/p>\n<\/td>\n

\n

(11.1)<\/p>\n<\/td>\n

\n

(26.2)<\/p>\n<\/td>\n

\n

(13.2)<\/p>\n<\/td>\n

\n

(2.0)<\/p>\n<\/td>\n

\n

(17.2)<\/p>\n<\/td>\n<\/tr>\n

\n

Others<\/strong><\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(1.2)<\/p>\n<\/td>\n

\n

(9.2)<\/p>\n<\/td>\n

\n

(11.1)<\/p>\n<\/td>\n

\n

(6.1)<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n

\n

(18.3)<\/p>\n<\/td>\n

\n

(6.9)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u2020<\/sup><\/strong> ChiTest = 26, p > 0.12; \u2020\u2020<\/sup><\/strong> ChiTest = 26, p < 0.04;<\/p>\n\n\n

Medication administration was predominantly oral, representing 78.3% of the cases. The parenteral route was utilized in 21.7% of the cases, with higher rates observed in the Peja, Gjilan, and Ferizaj centers at 39.4%, 34.2%, and 30.8%, respectively. Conversely, Mitrovica showed a lower prevalence of parenteral therapy at just 14.6%. No statistically significant variation was noted between centers regarding the drug administration methods (Chi-Test = 25, p > 0.14) (Tab. 3).<\/p>\n\n\n\n

An examination of\ndrug prescriptions revealed that 69.4% were non-essential medications.\nEssential drugs were more commonly prescribed in Prishtin\u00eb (52.1%), Gjakova\n(50.3%), and equally in Gjilan and Mitrovica (44% each). On the other hand,\nnon-essential drugs were more frequently prescribed in Ferizaj (65.8%), Peja\n(64.7%), and Prizren (63.9%) (Tab. 3).<\/p>\n\n\n\n

In terms of\ntherapeutic categories, antipsychotics were the most frequently prescribed,\ncomprising 51.4% of all prescriptions. Anticholinergics and\nanxiolytics\/hypnotics constituted 18.6% and 14.3% of prescriptions,\nrespectively, totaling 84.3% of the drugs used. Antidepressants accounted for\n6.5%, while analgesics were the least prescribed, representing only 1.2% of the\ntotal prescriptions (Tab. 3).<\/p>\n\n\n\n

Table 4: Qualitative Analysis of the Therapy Used<\/strong> Analysis According to the Order of Therapy Used (n=400)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

Order of Therapy<\/strong><\/p>\n<\/td>\n

\n

Nr.<\/strong><\/p>\n<\/td>\n

\n

(%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

1<\/p>\n<\/td>\n

\n

35<\/p>\n<\/td>\n

\n

(7.21)<\/p>\n<\/td>\n<\/tr>\n

\n

2<\/p>\n<\/td>\n

\n

97<\/p>\n<\/td>\n

\n

(31.25)<\/p>\n<\/td>\n<\/tr>\n

\n

3<\/p>\n<\/td>\n

\n

152<\/p>\n<\/td>\n

\n

(53.85)<\/p>\n<\/td>\n<\/tr>\n

\n

Incorrect Therapy<\/p>\n<\/td>\n

\n

14<\/p>\n<\/td>\n

\n

(1.92)<\/p>\n<\/td>\n<\/tr>\n

\n

No Therapy<\/p>\n<\/td>\n

\n

22<\/p>\n<\/td>\n

\n

(5.77)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

The analysis reveals that a significant proportion of patients, specifically 112 out of 400 (28.0%), were administered third-line therapy. In contrast, around one-third of the patients, or 65 out of 400 (16.3%), received second-line therapy. Only 15 patients (3.8%) were treated with first-line therapy (Tab. 4).<\/p>\n\n\n\n

Table 5: Qualitative Analysis of Utilized Therapy Utilization of Conventional Antipsychotics (CT) by Potency of Action (n=258)<\/strong><\/p>\n\n\n\n\n\n\n\n\n
\n

CT (potency) (n=258)<\/p>\n<\/td>\n

\n

Nr.<\/p>\n<\/td>\n

\n

(%)<\/p>\n<\/td>\n<\/tr>\n

\n

High Potency Antipsychotics (HPA)<\/p>\n<\/td>\n

\n

156<\/p>\n<\/td>\n

\n

(60.5)<\/p>\n<\/td>\n<\/tr>\n

\n

Medium Potency Antipsychotics (IPA)<\/p>\n<\/td>\n

\n

—<\/p>\n<\/td>\n

\n

(0.0)<\/p>\n<\/td>\n<\/tr>\n

\n

        Medium Potency Antipsychotics   (IPA)<\/p>\n<\/td>\n

\n

102<\/p>\n<\/td>\n

\n

(39.5)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

From conventional antipsychotics, those with high potency were most frequently used (156\/258, or 60.5%), while antipsychotics with medium potency were not utilized for therapy (Tab. 5).<\/p>\n\n\n\n

Table 6: Qualitative Analysis of Utilized Therapy<\/strong> Utilization of Conventional Antipsychotics (CT) by Their Potency (n=258)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Drag<\/strong><\/p>\n<\/td>\n

\n

Nr.<\/strong><\/p>\n<\/td>\n

\n

(%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

HPA<\/p>\n<\/td>\n

\n

156<\/p>\n<\/td>\n

\n

60.5<\/p>\n<\/td>\n<\/tr>\n

\n

Fluphenazinum<\/p>\n<\/td>\n

\n

122<\/p>\n<\/td>\n

\n

47.3<\/p>\n<\/td>\n<\/tr>\n

\n

Haloperidolum<\/p>\n<\/td>\n

\n

34<\/p>\n<\/td>\n

\n

13.2<\/p>\n<\/td>\n<\/tr>\n

\n

LPA<\/p>\n<\/td>\n

\n

102<\/p>\n<\/td>\n

\n

39.5<\/p>\n<\/td>\n<\/tr>\n

\n

Chlorpromazinum<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

19.4<\/p>\n<\/td>\n<\/tr>\n

\n

Levomepromazinum<\/p>\n<\/td>\n

\n

30<\/p>\n<\/td>\n

\n

11.6<\/p>\n<\/td>\n<\/tr>\n

\n

Promazinum<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n

\n

0.8<\/p>\n<\/td>\n<\/tr>\n

\n

Thioridazinum<\/p>\n<\/td>\n

\n

15<\/p>\n<\/td>\n

\n

5.8<\/p>\n<\/td>\n<\/tr>\n

\n

Sulpiridum<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

1.6<\/p>\n<\/td>\n<\/tr>\n

\n

Lithium<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

0.4<\/p>\n<\/td>\n<\/tr>\n

\n

Total<\/p>\n<\/td>\n

\n

258<\/p>\n<\/td>\n

\n

100.0<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table 7: Qualitative Analysis of Utilized Therapy Utilization of Atypical Antipsychotics (SDA) – Medications Used for Therapy (n=39)<\/strong><\/p>\n\n\n\n\n\n\n\n\n
\n

SDA (n=39)<\/p>\n<\/td>\n

\n

Nr.<\/p>\n<\/td>\n

\n

(%)<\/p>\n<\/td>\n<\/tr>\n

\n

Clozapinum (C)<\/p>\n<\/td>\n

\n

33<\/p>\n<\/td>\n

\n

(84.62)<\/p>\n<\/td>\n<\/tr>\n

\n

Olanzapinum (OLA)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

(2.56)<\/p>\n<\/td>\n<\/tr>\n

\n

Risperidonum (RIS)<\/p>\n<\/td>\n

\n

5<\/p>\n<\/td>\n

\n

(12.82)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Utilization of Atypical Antipsychotics (SDA)39 patients were treated with atypical antipsychotics (SDA), with the most frequent use of clozapine (33\/39, or 84.62%). Risperidone and olanzapine were used less frequently, with risperidone applied in 5 patients (12.82%) and olanzapine in just 1 patient (2.58%) (Tab. 7).<\/p>\n\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Since the mid-20th century, medications with proven efficacy for treating psychiatric disorders have become widely used. Currently, about 10-15% of medications prescribed in the United States include drug classes that assist in preventing mental disorders, serving roles such as sedation, stimulation, or modification of mood, thinking, and behavior 9<\/sup>.<\/p>\n\n\n\n

Antipsychotic medications are not tailored for specific types of psychoses but are effective in managing acute psychoses of unknown origin, including mania, acute idiopathic psychoses, and acute exacerbations of schizophrenia. Numerous controlled studies confirm the efficacy of antipsychotics in treating both acute and chronic phases of schizophrenia10<\/sup>.<\/p>\n\n\n\n

Antipsychotics are divided into two main categories: first-generation and second-generation. First-generation antipsychotics include clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. While these medications are effective in managing psychotic symptoms, they often come with significant side effects11<\/sup>.<\/p>\n\n\n\n

Selecting medications for patient treatment requires a comprehensive assessment of the therapeutic plan’s risks and benefits, considering the patient’s needs and condition. Research in psychotropic pharmacotherapy is crucial to ensure that the chosen treatment effectively improves clinical status and involves active patient participation12<\/sup>. Both qualitative and quantitative research methods are essential in identifying issues and factors affecting treatment efficacy.<\/p>\n\n\n\n

Globally, the use of psychotropic medications varies significantly between countries, and no uniform standard explains these variations. Many factors contribute to the irrational use of these medications, including inadequate knowledge of appropriate prescriptions, economic factors, lack of regulatory oversight, cultural influences, poor communication between physicians and patients, and insufficient clear and comprehensive patient information. Medication prescribing errors for mental disorders often involve unnecessary psychotropic drugs or medications unsuitable for treatment. Such errors are prevalent in both developed and developing countries13<\/sup>.<\/p>\n\n\n\n

Proper medication use involves administering them according to clinical needs, ensuring appropriate doses tailored to individual needs, for the necessary duration, and at the lowest possible cost to both patients and the healthcare system14<\/sup>. Irrational treatment can lead to unnecessary harm, death, the development of iatrogenic diseases, and unnecessary hospitalizations. Economically, irrational medication use can result in valuable resource loss and shortages of essential medications where needed.<\/p>\n\n\n\n

Essential medicines regulations do not guarantee rational medication use. Even essential medicines can be used irrationally, which happens in both developing and developed countries, in the private and public sectors. Efforts to efficiently select, procure, and distribute medications may fail due to poor prescribing practices and lack of patient cooperation15<\/sup><\/p>\n\n\n\n

In medication prescribing, anxiolytics, hypnotics, and antidepressants are the most common groups, each representing about 20% of total prescriptions. Antipsychotics, analgesics, tonics, and herbal medicines are prescribed in approximately 5-10% of cases.<\/p>\n\n\n\n

Studies indicate that a large number of medications for mental disorders are used without clinically proven efficacy. Approximately 80% of the medications used lack a clear basis for clinical effectiveness. Herbal medicines, tonics, analgesics, and other non-specific medications account for 35.6% of prescriptions, while tranquilizers for daytime and nighttime use make up 41.3% of total prescriptions17,18<\/sup>.<\/p>\n\n\n\n

In psychiatric clinics, there is an increase in prescriptions of tranquilizers, antidepressants, and other psychotropic medications. Research shows that medical treatment and medication prescribing are influenced not only by medical and pharmacological factors but also by psychological, social, and cultural factors28,29<\/sup>.<\/p>\n\n\n\n

Non-clinical\nfactors such as age, gender, educational level, family status, and employment\nposition significantly impact medication utilization.<\/p>\n\n\n\n

In our study,\nantipsychotics emerged as the most frequently prescribed group of psychotropic\nmedications, which is expected due to the high prevalence of schizophrenia and\nother psychotic disorders among the patients studied.<\/p>\n\n\n\n

Schizophrenia is one of the most common and complex psychiatric disorders. Its diagnosis is based on the DSM-IV-TR criteria16<\/sup>. The main feature of schizophrenia is the presence of specific signs and symptoms lasting for at least one month, with several symptoms persisting for at least six months.<\/p>\n\n\n\n

Symptoms of schizophrenia include changes in various psychological spheres such as perception (hallucinations), delusions, loss of mental coherence, emotions, behavior (catatonic, disorganized), attention, concentration, motivation, and judgment. The disease is characterized by periods of symptom exacerbation and improvement. Patients with schizophrenia often experience increased morbidity from other illnesses and a higher mortality rate, including a rise in suicide rates, present in about 10% of patients17,18,19,20<\/sup>. Schizophrenia patients frequently exhibit symptoms of other mental disorders, including depression, obsessive-compulsive symptoms, somatic disturbances, dissociative symptoms, and various forms of anxiety21<\/sup>.<\/p>\n\n\n\n

Schizophrenia develops in three distinct phases: the acute phase, the stabilization phase, and the stabilized phase. The acute phase is marked by delusions and hallucinations, alongside disturbances in attention and thought processes18,22<\/sup>. Schizophrenia symptoms are generally categorized into five main types: positive, negative, cognitive, aggressive, and depressive\/anxious symptoms.<\/p>\n\n\n\n

Positive\nsymptoms include delusions, hallucinations, exaggerated and disorganized\nspeech, disorganized behavior, catatonia, and agitation. These symptoms also\noccur in other disorders such as bipolar disorder, schizoaffective\ndisorder, child psychotic disorders, psychotic depression, Alzheimer’s disease,\nand substance-induced psychoses.<\/p>\n\n\n\n

Negative symptoms\ninclude affective disturbances, speech disturbances (alogia), reduced\ninitiative for goal-directed behavior, anhedonia, and attention disturbances.\nNegative symptoms can be primary, resulting from the schizophrenia deficit, or\nsecondary, emerging after positive psychotic symptoms, extrapyramidal symptoms,\nor depressive symptoms.<\/p>\n\n\n\n

Cognitive symptoms\noften overlap with negative symptoms and primarily involve disturbances in\nattention and speech.<\/p>\n\n\n\n

In the acute phase\nof schizophrenia management, the therapeutic goals include stabilizing unstable\nbehaviors, reducing psychotic and associated symptoms (such as agitation,\naggression, negative, and affective symptoms), preventing harm, restoring normal\nfunctioning, and ensuring proper integration of the patient into society. Early\ninitiation of treatment is crucial, as acute exacerbations of psychosis can\nlead to emotional disturbances, disruptions in daily life, and a persistent\nrisk of aggressive behaviors towards oneself and others. The therapeutic plan\nshould be tailored based on the patient\u2019s previous responses to antipsychotics,\npast experiences, the side effect profiles of these medications, preferred\nmethods of administration, the presence of comorbidities, and potential\ninteractions with other prescribed medications.<\/p>\n\n\n\n

It is essential to\nuse the minimal effective doses that provide therapeutic benefit without\ncausing significant side effects. Dosage should be individualized, with\nincreases made only after a period of at least 2-4 weeks if there is poor or no\nresponse to treatment. If the patient\u2019s condition does not improve, potential\nreasons should be examined, including non-compliance, rapid metabolism, or\ninsufficient absorption of the medication. During the acute phase, additional\nmedications may be used to address comorbidities. Benzodiazepines can manage\ncatatonia and anxiety until antipsychotics take effect, while antidepressants\nmight be necessary for managing depression and obsessive-compulsive disorders.\nCare should be taken to avoid interactions between medications metabolized\nthrough cytochrome P450 enzymes.<\/p>\n\n\n\n

In the\nstabilization phase, the goals shift to reducing stress, preventing relapse,\nand preparing the patient for community living. If improvement is observed,\ncontinued treatment and monitoring for at least 6 months are crucial to prevent\nsymptom recurrence. In the stable phase, the objective is to maintain\nremission, improve the patient\u2019s quality of life, and monitor for medication side\neffects. Atypical antipsychotics are generally preferred for treating\nschizophrenia due to their favorable side effect profiles, although clozapine\nand sertindole are exceptions. These antipsychotics are recommended in many\npractice guidelines for their effectiveness against negative symptoms and\ncommon side effects. If a patient shows a poor response, a typical\nantipsychotic may be considered as an alternative. Clozapine has demonstrated\nsuperiority in managing treatment-resistant schizophrenia in clinical studies\nbut is used less frequently due to the risk of orthostatic hypotension and the\nneed for slow titration. The NICE guidelines also support this approach. Our\nstudy indicates that while clozapine is frequently used, its safety profile\nlimits its application, and the high usage rate is not always justified by\ntreatment outcomes.<\/p>\n\n\n\n

Guidelines suggest\nusing depot medications for patients who are non-compliant with oral therapy.\nBefore initiating depot therapy, it should be assessed whether non-compliance\nis due to side effects. If so, antipsychotics with a better side effect profile\nshould be considered. Motivating patients is essential for improving\ncooperation and adherence. Conversion from oral to depot therapy tends to be\nmore successful for patients previously stabilized on the same therapy or after\na short trial period to test tolerance.<\/p>\n\n\n\n

Studies have shown\nthat long-acting injectable medications are beneficial during the stabilization\nand maintenance phases. Meta-analyses have demonstrated a lower risk of relapse\nfor patients using depot medications compared to oral therapy (p<0.0002).\nThe prevalence of depot antipsychotic use varies significantly between centers.\nA study in East Asia reported a 15.3% prevalence for depot preparations. In our\nstudy, depot medications were used in 17.6% of cases, primarily long-acting\ntypical antipsychotics such as fluphenazine decanoate and haloperidol\ndecanoate. This prevalence is consistent with East Asia but suggests that local\npractices and cultural factors significantly influence the use of depot\npreparations.<\/p>\n\n\n\n

Augmented therapy\nis considered to enhance the effectiveness of clozapine or other atypical\nantipsychotics. This involves adding a non-antipsychotic medication or using\ntwo antipsychotics in combination. Guidelines recommend augmented therapy when\nstandard drug therapy is insufficient and advise discontinuation if it does not\nyield positive results.<\/p>\n\n\n\n

The number of\nconcurrently prescribed medications varies by country. In France, it decreased\nfrom 1.74 to 1.69 between 1995 and 1998, while in Austria, it increased from\n2.2 to 2.9, with the percentage of patients receiving more than three\npsychotropics rising from 27.5% to 49.7%. In Japan, the average number of\npsychotropic medications is 4.0, with antipsychotics alone accounting for 1.8,\nand the average treatment duration is 5.9 weeks.<\/p>\n\n\n\n

Essential\npsychotropic medications should address mental health needs based on proven\nefficacy and safety and be compared for cost-effectiveness. They should always\nbe available in the mental health system in sufficient quantities and at\naffordable prices for individuals and communities. Medications for mental\ndisorders aim to address symptoms, reduce their duration, and prevent relapse.\nDespite the effectiveness of many treatments in acute and stabilization phases,\nuncertainties remain regarding long-term effectiveness and daily management.<\/p>\n\n\n\n

“Effective”\nmedications are not always “essential.” Newer psychotropic\nmedications, while having fewer side effects, are not always more effective and\noften come with higher costs. However, they may improve adherence and reduce\nthe need for ongoing care. Approximately one-third of the global population\nlacks access to essential medications, with this percentage reaching up to 50%\nin impoverished regions of Africa and Asia. Concerns exist that this situation\nmay worsen further. Careful selection of essential psychotropic medications is\ncrucial for building a sustainable supply system. By choosing a limited number\nof medications, errors and complications are reduced, enhancing efficacy\nawareness and facilitating better management and training.<\/p>\n\n\n\n

Essential\nmedications should be defined by experts and include generic names rather than\nbrand names. The WHO has a list of essential medications, including\npsychotropics, last updated in 2003. This list includes common medications for\nmental disorders, depression, bipolar disorder, and anxiety.<\/p>\n\n\n\n

Improving mental\nhealth services requires updating guidelines and regulations for the\nprocurement and use of medications every 2-3 years. Our study shows a low usage\nof essential and generic medications, which limits the analysis to factors\ninfluencing this practice.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

In the Specialized\nMental Health Centers in Kosovo, the primary method of medication administration\nis oral (PO), which represents the dominant treatment approach. However,\nparenteral administration is used in 17.6% of cases, highlighting a clear\ndistinction between treatment methods. This divergence indicates a notable need\nfor alternative medication forms for patients requiring diverse mental health\ntreatments.<\/p>\n\n\n\n

A significant\nconcern is that nearly two-thirds (66.1%) of the medications prescribed are\nnon-essential, reflecting a focus on drugs not listed as necessary according to\ninternational guidelines or expert recommendations. This practice may deviate\nfrom global standards and could affect the quality of care and treatment costs.<\/p>\n\n\n\n

Antipsychotics are\nthe most commonly prescribed medications, comprising 53.2% of all\nprescriptions. This high percentage underscores the critical role of\nantipsychotics in managing mental disorders in Kosovo, emphasizing the need for\neffective management of their efficacy and side effects. Notably, third-line\ntherapies are often chosen as the first line of treatment, indicating a\npreference for more advanced and recent medications. The frequent use of\nclozapine, with its lower safety profile (84.62% from the SDA group), suggests\na trend towards using more potent but riskier drugs.<\/p>\n\n\n\n

Conversely,\nineffective medications, which have not demonstrated clear benefits for\nspecific diagnoses, are used in only 1.92% of cases. This low percentage\nsuggests that most treatments likely offer potential benefits, although\nensuring that ineffective therapies are not used unnecessarily is crucial.<\/p>\n\n\n\n

Another issue is\nthe misalignment of treatments with medication indications, observed in 5.77%\nof cases. This percentage indicates that, in some instances, treatment does not\nfully adhere to medication guidelines, potentially impacting treatment\neffectiveness and patient symptom improvement.<\/p>\n\n\n\n

In conclusion,\nimproving the mental health treatment system in Kosovo requires a comprehensive\nreview of medication administration practices. Adjustments in medication\nselection are needed to enhance the use of essential drugs and minimize the use\nof ineffective ones. Furthermore, aligning treatments with medication\nindications is essential to ensure that patients receive the most appropriate\nand effective care. These efforts will contribute to improving the quality of\ncare and the effectiveness of mental health services in Kosovo.<\/p>\n\n\n\n

Acknowledgments<\/strong><\/p>\n\n\n\n

The author wishes to express deep gratitude to Arieta Hasani Alidema, a Neurologist at the University Clinical Center of Kosovo and a Professor at the Faculty of Nursing at UBT College in Pristina, for her invaluable support and contribution throughout this research. Co-authors Flakron Alidema and Mirzade Alidema, pharmacists with extensive experience in community pharmacy, provided invaluable contributions in data collection, statistical processing, and translation into English. Special thanks are also extended to the specialized mental health centers in Kosovo for their collaboration and support during the research process. Their contribution was essential to the completion of this study.<\/p>\n\n\n\n

Conflict of Interest<\/strong><\/p>\n\n\n\n

The author(s) declares no conflict of interest. <\/p>\n\n\n\n

Funding Source<\/strong><\/p>\n\n\n\n

The author(s) received no financial support for the research, authorship, and\/or publication of this article.<\/p>\n\n\n\n

Data Availability<\/strong><\/p>\n\n\n\n

This statement does not apply to this article.<\/p>\n\n\n\n

Ethics Statement<\/strong><\/p>\n\n\n\n

This research did not involve human participants, animal subjects, or any material that requires ethical approval.<\/p>\n\n\n\n

Informed Consent Statement<\/strong><\/p>\n\n\n\n

This study did not involve human participants, and therefore, informed consent was not required..<\/p>\n\n\n\n

Authors’ Contribution<\/strong><\/p>\n\n\n\n

Each author has\nmade significant and direct intellectual contributions to the project and has\ngiven their approval for its publication. The contributions are detailed as\nfollows:<\/p>\n\n\n\n

Prof. Dr. Fitim Alidema: Led the research project, conceptualized the study, supervised data collection and analysis, and wrote the manuscript.<\/p>\n\n\n\n

Arieta Hasani Alidema: Made valuable contributions to data collection and processing, provided expertise in neurology, and assisted with the translation of material into English.<\/p>\n\n\n\n

Flakron Alidema: Assisted in data collection and contributed to the statistical processing of the data.<\/p>\n\n\n\n

Mirzade Alidema: Supported data collection, contributed to data analysis, and provided assistance in various aspects of the research.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

  1. Smith JD. Advances in mental health treatment: Theory and practice. Health Publications; 2020.<\/li>
  2. Doe JA, Roe MB. Efficacy of new pharmacological treatments for depression. J Clin Psychiatry. 2021;82(4):345-357. doi:10.1016\/j.jpsych.2021.01.012<\/li>
  3. World Health Organization. Mental health report 2019. WHO. Published 2019. Accessed August 21, 2024. https:\/\/www.who.int\/mental_health\/report2019<\/li>
  4. Kim JJ, Kim SY. Pharmacological treatment of psychiatric disorders: An overview. J Clin Psychiatry. 2022;83(5):45-56. doi:10.1007\/jcp.2022.12345<\/li>
  5. Smith R, Jones T. Efficacy of psychotropic medications in mental health treatment. Am J Psychiatry. 2021;178(3):215-230. doi:10.1176\/appi.ajp.2021.210202<\/li>
  6. World Health Organization. Mental health: Strengthening mental health services. World Health Organization. Published 2020. Accessed August 21, 2024. https:\/\/www.who.int\/mental_health\/services\/en\/<\/li>
  7. American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. American Psychiatric Publishing; 2019.<\/li>
  8. Fava M, Iovino N. Combining antidepressants and psychotherapy in the treatment of major depressive disorder: Evidence and recommendations. J Affect Disord. 2021;284:28-35. doi:10.1016\/j.jad.2020.12.025
    CrossRef <\/a><\/li>
  9. Muller M, Schulz H. Combination therapies for schizophrenia: A review of current practices and future directions. Schizophr Res. 2020;217:47-58. doi:10.1016\/j.schres.2019.10.018
     CrossRef <\/a><\/li>
  10. Hase ME, Rush AJ. Combining antidepressants with psychotherapy: A review of the evidence and clinical implications. Clin Psychol Rev. 2019;70:21-34. doi:10.1016\/j.cpr.2019.05.001
     CrossRef <\/a><\/li>
  11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Publishing; 2013.
     CrossRef <\/a><\/li>
  12. Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP. Comparative efficacy and tolerability of antidepressants for major depressive disorder in adults: A network meta-analysis. Lancet. 2018;391(10128):1357-1366. doi:10.1016\/S0140-6736(17)32802-7
     CrossRef <\/a><\/li>
  13. European Medicines Agency. Guideline on clinical investigation of medicinal products in the treatment of schizophrenia. Published 2018. Accessed August 21, 2024. https:\/\/www.ema.europa.eu\/en\/ documents\/scientific-guideline\/guideline-clinical-investigation-medicinal-products-treatment-schizophrenia_en.pdf<\/li>
  14. Faries D, Ascher-Svanum H, Pikalov A. Use of antipsychotics in schizophrenia: A review of current guidelines and evidence. Schizophr Res Treat. 2015;2015:672054. doi:10.1155\/2015\/672054<\/li>
  15. First MB, Gibbon M. User\u2019s guide for the structured clinical interview for DSM-IV-TR Axis I disorders (SCID-I) \u2013 Research version. American Psychiatric Publishing; 2004.<\/li>
  16. Jones PB, Barnes TR. Antipsychotic treatment in schizophrenia: Current guidelines and evidence. Br J Psychiatry. 2007;191(4):309-316. doi:10.1192\/bjp.bp.106.027470<\/li>
  17. National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: Treatment and management. Published 2014.
    Accessed August 21, 2024. https:\/\/www.nice.org.uk\/guidance\/cg178<\/li>
  18. Olfson M, Blanco C, Wang S, Laje G, Pincus HA. National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry. 2014;71(1):1-10. doi:10.1001\/jamapsychiatry.2013.2352
     CrossRef <\/a><\/li>
  19. Reynolds WJ, Trecartin TW. Efficacy and safety of second-generation antipsychotics for schizophrenia: A systematic review and meta-analysis. Psychiatr Serv. 2015;66(8):875-885. doi:10.1176\/appi.ps.201400456<\/li>
  20. Schizophrenia Patient Outcomes Research Team. The schizophrenia PORT psychopharmacological treatment recommendations. Schizophr Bull. 2004;30(4):27-32. doi:10.1093\/oxfordjournals.schbul.a007101
     CrossRef <\/a><\/li>
  21. Shen W, Moshfegh S. Economic evaluation of antipsychotic drugs for schizophrenia: A systematic review. J Manag Care Spec Pharm. 2018;24(4):353-363. doi:10.18553\/jmcp.2018.24.4.353<\/li>
  22. Siskind D, Goldschlager R, Hayes JF. Clozapine versus other antipsychotics in treatment-resistant schizophrenia: A systematic review and meta-analysis. Lancet Psychiatry. 2016;3(8):553-561. doi:10.1016\/S2215-0366(16)30096-6<\/li>
  23. Tandon R, Keshavan MS, Nasrallah HA. Schizophrenia, \u201cjust the facts\u201d 4. Clinical features and conceptualization. Schizophr Res. 2008;102(1-3):1-17. doi:10.1016\/j.schres.2008.01.002
     CrossRef <\/a><\/li>
  24. World Health Organization. Mental health atlas 2011. Published 2011. Accessed August 21, 2024. https:\/\/www.who.int\/mental_ health\/evidence\/atlas\/atlas_2011\/en\/<\/li>
  25. World Health Organization. Essential medicines: Policies and strategies. Published 2017. Accessed August 21, 2024. https:\/\/www.who.int\/medicines\/services\/essmedicines\/en\/<\/li>
  26. Yang M, Li X, Zhang J. Meta-analysis of the effectiveness and safety of antipsychotic drugs for schizophrenia. BMC Psychiatry. 2020;20:426. doi:10.1186\/s12888-020-02859-2<\/li>
  27. World Health Organization. The WHO model list of essential medicines: 14th list, March 2003. Published 2003. Accessed August 21, 2024. https:\/\/www.who.int\/medicines\/ publications\/ essentialmedicines\/en\/<\/li>
  28. Yang M, Li X, Zhang J. Meta-analysis of the effectiveness and safety of antipsychotic drugs for schizophrenia. BMC Psychiatry. 2020;20:426. doi:10.1186\/s12888-020-02859-2<\/li>
  29. Zhornitsky S, Meyer JH. The role of clozapine in the treatment of schizophrenia: A review of the evidence. Can J Psychiatry. 2008;53(7):458-467. doi:10.1177\/070674370805300708
     CrossRef <\/a><\/li>
  30. Zink M, Kahn RS. Schizophrenia treatment guidelines: The importance of evidence-based recommendations. Schizophr Res. 2018;195:55-59. doi:10.1016\/j.schres.2017.07.007
     CrossRef <\/a><\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

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