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18 2012
I
1990 .
1980 .
,
1960 .
1960-70 .
1950
1960
1990
2000
() -
: . .,%
I- , II-
, III ,
IV- , V-
, %
79,0%
77,0%
76,7%
75,0%
73,0%
71,0%
69,0%
67,0%
65,0%
14
72,0%
13
65,9%
63,8%
63,0%
61,7%
61,0%
60,1%
59,0%
59,6%
57,0%
55,0%
1993
1998
2000
, .
700
642,3
600
500
400
302,3
300
159,8
200
100
17,4
44,1
0
1
1-; 2- ; 3- ;
4- ( )
; 5-
()
;
;
(..
)
() (adherence):
(R.B. Haynes, 1979)
noncompliance adherence concordance ():
(
80% )
(2080% )
()
***
(
)
60%
> 20%
% ,
()
75%
80
70
50%
60
50
40
25%
30
20
10
0
7-10
1Lam
YWF et al. Poster presented at: Annual Meeting of NCDEU; June 10-13, 2002; Boca Raton, Florida.
2Weiden PJ, Zygmunt A. J Prac Psych Behav Hlth. 1997;March:106-110.
()
(%)
48
5
(%)
82
41
74
(n=127)
110
(n=1710)
6,4
11,9
1,98
P=0.0042
1130
16,1
(n=1166)
2,82
P<0.0001
>30
(n=1122)
21,6
<0.004
3,96
P<0.0001
100
30 ,
4,2*
80
72,1
60
40
20
20
0
* .
Herings RMC, Erkens JA. The PHARMO Institute, The Netherlands; Submitted to BMJ.
(QALY)
(L. Lenert et al., 2004; P. Mohr et al., 2004)
0,75
0,42
-0,09
-0,05.
-0,05.
-0,14.
-0,22.
-0,22.
- 0,33.
- 0,13
54873,96
II
6748,14
876,29
2393,61
0,00
0,00
0,00
1427,36
, .
, .
, .
43 512,70
3 660,96
1 168,62
1 074,00
56 675,49
, .
31 833,96
490,11
46,32
,
, II
(.. , ., 2007)
()
19
(, ,
, , )
( , ,
)
(, )
( , , ,
)
(, )
( , , , )
, 1 5
% , % , % , % , % ,
EMEA
4449
2550
450
265
1184
4: , , , (>5
) , ?
EMEA 95%
ADHES (2010):
19%
37%
23%
24%
35%
21%
22%
...
22
60%
1 5
:
:
,
, (
- )
()
()
,
( )
,
(, )
50%
(.. , 2006, )
-
,
-
2001
14%
2%
2002
2%
0,2%
36%
14%
3% 3%
29%
46%
51%
(.. , 2006, )
/
(80% )
: . , ,
Rating of Medication Influences, ROMI (P. Weiden et al., 1994)
Treatment Compliance Interview, TCI (P. Weiden et al., 1994);
Drug Attitude Inventory (DAI (TP Hogan et al., 1983); Medication Adherence Rating Scale,
MARS (K Thompson et al., 2000).
() (20% ):
, / ).
(..
, .. , 2002)
PANSS (S.R. Key et al., 1987).
(R. Kemp & A. David, 1996).
(G. Szmukler et al., 1994)
(.)
- ASC (S.G. Dott et al.,
2001).
,
()
?
:
()
(
- )
()
?
?
?
???
National Association of State Mental Health Program Directors. Technical Report on Psychiatric Polypharmacy; 2001.
(.. , 2007).
( -)
1,0
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,1
0,0
-0,1
0
50
100
150
200
250
300
350
400
,
,
Pekkala E.& Merinder L. Psychoeducation for schizophrenia
(Cochrane Review). // Cochrane Library, Issue 2, Oxford: Update Software, 2003
()
.
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(
. , )
(
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.
. .
.
.
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.
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.
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