Sultzer David L
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, and Gero/Neuropsychiatry Division, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
Dement Geriatr Cogn Disord. 2004;17(1-2):78-90. doi: 10.1159/000074279. Epub 2003 Oct 17.
Psychosis is common in patients with Alzheimer's disease (AD) and contributes substantially to patient morbidity and caregiver distress. Antipsychotic medications are used to treat psychosis and other psychiatric or behavioral symptoms in AD, although optimal treatment guidelines have been elusive. Choosing the most advantageous medication for an individual patient is challenging. This article provides an overview of clinical management principles and medication treatment strategies for patients with AD and psychosis. Effects of individual medications are also described. Medications in the conventional neuroleptic, atypical antipsychotic, cholinesterase inhibitor, and serotonergic classes have been shown to ameliorate psychosis and behavioral symptoms in patients with AD, although the evidence is not conclusive for many medications. Side effects vary substantially across medication classes and modestly among individual patients. Improvement in agitation, aggression, or other behaviors with antipsychotic medication treatment may not depend on distinct antipsychotic effects. In contrast, there is preliminary evidence that delusions and hallucinations may respond to treatment with medications outside the antipsychotic class. Many important clinical questions warrant further research study. In particular, studies to compare how individual symptoms respond to different medications, and to examine how to best manage overlapping symptoms or incomplete treatment response are needed.
精神病在阿尔茨海默病（AD）患者中很常见，并且在很大程度上导致了患者的发病率和照料者的痛苦。抗精神病药物用于治疗AD患者的精神病以及其他精神或行为症状，尽管最佳治疗指南一直难以捉摸。为个体患者选择最有利的药物具有挑战性。本文概述了AD合并精神病患者的临床管理原则和药物治疗策略。还描述了个别药物的作用。传统抗精神病药、非典型抗精神病药、胆碱酯酶抑制剂和血清素能类药物已被证明可改善AD患者的精神病和行为症状，尽管许多药物的证据并不确凿。不同药物类别的副作用差异很大，个体患者之间的差异较小。抗精神病药物治疗对激越、攻击或其他行为的改善可能并不取决于独特的抗精神病作用。相比之下，有初步证据表明，妄想和幻觉可能对抗精神病药物类别以外的药物治疗有反应。许多重要的临床问题值得进一步研究。特别是，需要进行研究以比较个体症状对不同药物的反应，并研究如何最好地管理重叠症状或不完全的治疗反应。
