Padrões de Prescrição na PHDA no Adulto: A Realidade do CHUC
DOI:
https://doi.org/10.51338/rppsm.476Palavras-chave:
Adulto, Lisdexanfetamina, Metilfenidato, Perturbação de Hiperatividade e Défice de Atenção/ tratamento farmacológicoResumo
Introdução: A perturbação de hiperatividade e défice de atenção (PHDA) é uma das patologias neuropsiquiátricas mais comuns, afetando cerca de 2%‑4% da população adulta. A intervenção farmacoterapêutica de primeira linha são os psicoestimulantes como o metilfenidato e as anfetaminas. Geralmente, A terapêutica farmacológica de segunda linha é utilizada quando há ineficácia, intolerância ou contraindicação para o uso de estimulantes.Métodos: Estudo retrospetivo observacional dos doentes seguidos na Consulta de Neurodesenvolvimento no Serviço de Psiquiatria do Centro Hospitalar e Universitário de Coimbra (CHUC), referente a 2 anos e 9 meses de atividade (Janeiro de 2019 a Setembro de 2021) com o diagnóstico de PHDA, com o objetivo de caracterizar a amostra do ponto de vista sociodemográfico e de prescrição psicofarmacológica. Dados colhidos em setembro de 2021, através do SClínico. Tratamento dos dados em Excel (versão 16.46).
Resultados: A amostra inclui 416 doentes, sendo encontrados 82 doentes com o diagnóstico de PHDA. O estudo revelou que 73% dos participantes eram do sexo masculino, com uma idade média de 21 anos. Dos doentes com diagnóstico de PHDA, 52,4% registam o diagnóstico isoladamente, enquanto que 47,6% tem PHDA em comorbilidade com outra patologia psiquiátrica. Quanto à prescrição psicofarmacológica, 65,9% medicados com metilfenidato, 46,3% medicados com a dose máxima (54 mg uma vez por dia), 7,4% medicados com 36 ou 40 mg uma vez por dia em ambos os casos, estando outras doses prescritas numa frequência inferior.
Conclusão: Estudos recentes internacionais referem uma prevalência de 90%‑92% da prescrição de metilfenidato em doentes com PHDA, contudo a realidade encontrada no CHUC (65,9%) é consideravelmente inferior. Esta prevalência pode dever‑se a efeitos adversos intoleráveis, baixa adesão terapêutica ou à presença de múltiplas comorbilidades que pode condicionar as prescrições. A prescrição deverá ser sempre individualizada e de acordo com a psicopatologia apresentada. De futuro, são necessários mais estudos para avaliar a realidade da prescrição portuguesa.
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