痴呆的精神行为症状.ppt

Psychiatric symptoms were improved more by secondgeneration antipsychotic drugs than by placebo in 421 outpatients with Alzheimer’s disease who had psychotic symptoms or agitation. For patients who completed 12 weeks of treatment witholanzapine奥氮平, quetiapine喹硫平, or risperidone利培酮, the proportions who were “much” or “very much” improved were 45%, 52%, and 61%, compared to 40% who were improved with placebo. Sultzer et al (CME, p. 844) found that treatment effects in the Clinical Antipsychotic Trials of Intervention Effectiveness—Alzheimer’s Disease (CATIEAD) varied among the antipsychotics and specific symptoms. The effect on hostility—including anger, aggression, and paranoia—was most notable. None of the drugs, however, improved cognition, depression, functional abilities, care needs, or quality of life. Dr. Susan Schultz reviews these CATIE-AD results in an editorial on p. 787. Key Point: Mild behavioural problems can be managed with non-pharmacologic methods Non-pharmacologic interventions aim to: Address the underlying and unmet needs that are causing the inappropriate behaviour Change the relationship between antecedents, behaviour and reinforcement Reduce the stimulation levels that may result in overreaction in the cognitively impaired person References Cohen-Mansfield J. Assessment of disruptive behaviour/agitation in the elderly: function, methods, and difficulties. J Geriatr Psychiatry Neurol. 1995;8(1):52-60. Caltagirone C et al. Drugs Aging. 2005;22(Suppl 1):1-26. 国内多中心研究 (孙新宇, 于欣，等. 中华精神科杂志, 2004) 国内多中心研究 (孙新宇, 于欣，等. 中华精神科杂志, 2004) 护养院中喹硫平治疗认知功能下降 40 20 0 -20 -40 -60 安慰剂 卡巴拉汀 喹硫平 与基线相比SIB分数的变化 * *6周治疗时间 恶化 改善 Ballard C, et al. BMJ 2005;330:874 非典型抗精神病药物的使用 Add your title in here 体重增加 糖尿病 (血糖升高) 帕金森综合征 迟发性运动障碍：传统抗精神病药物引起TD，造成运动功能障碍 嗜睡 奥氮平（1.3%）vs 安慰剂（0.4%） 脑血管事件 利培酮（1.3%）vs 安慰剂（0.6%） “‘适应症外’使用‘非典型抗精神病药物’治疗老年痴呆患者行为障碍的临床研究显示，与使用安慰剂治疗的患者相比，非典型抗精神病药物治疗相关的死亡率高1.6-1.7倍 。” 绝对危险未报道。 FDA关于抗精神病药物用于老年患者行为障碍治疗的建议 /bbs/topics/ANSWERS/2005/