养老院和急性老年病房中痴呆老年患者的行为症状及精神药物的使用

Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards.

作者信息

Pitkala K H, Laurila J V, Strandberg T E, Tilvis R S

机构信息

Department of Medicine, Geriatric Clinic, Helsinki University Hospital, Finland.

出版信息

Int Psychogeriatr. 2004 Mar;16(1):61-74. doi: 10.1017/s1041610204000079.

DOI:10.1017/s1041610204000079

PMID:15190997

Abstract

OBJECTIVES

To describe the prevalence of various psychiatric and behavioral symptoms among patients with dementia in nursing homes and acute geriatric wards and to investigate the administration of psychotropic medications to these patients.

METHODS

425 consecutive patients (>70 years) in six acute geriatric wards in two city hospitals and seven nursing homes in Helsinki, Finland, were assessed with an extensive interview, cognitive tests, and attention tests. Of these, 255 were judged to have dementia according to the following information: previous dementia diagnoses and their adequacy, results of CT scans, Mini-mental State Examination (MMSE) tests, Clinical Dementia Scale (CDR) tests, and DSM-IV criteria. Psychiatric and behavioral symptoms were recorded over two weeks for each patient.

RESULTS

Psychiatric and behavioral symptoms were very common among patients with dementia in both settings. In all, 48% presented with psychotic symptoms (delusions, visual or auditory hallucinations, misidentifications or paranoid symptoms), 43% with depression, 26% agitation, and 26% apathy. Use of psychotropic drugs was also common: 87% were on at least one psychotropic drug, 66% took at least two, 36% at least three, and 11% four or more psychotropic drugs. Of the patients with dementia, 42% were on conventional antipsychotics, and 34% on anxiolytics despite their known side-effects. Only 13% were on atypical antipsychotics and 3% on cholinesterase inhibitors. The use of selective serotonin reuptake inhibitors (SSRIs) was common (31%) among the patients. A surprising finding was that drugs with anticholinergic effects were also frequently (20%) used.

CONCLUSION

Both behavioural symptoms and use of psychotropic drugs are very common among dementia patients in institutional settings. The frequent use of potentially harmful drugs implies a need for education among physicians taking care of these patients.

摘要

目的

描述养老院和急性老年病房中痴呆患者各种精神和行为症状的患病率，并调查这些患者精神药物的使用情况。

方法

对芬兰赫尔辛基两家城市医院的六个急性老年病房和七家养老院的425名连续患者（年龄>70岁）进行了广泛的访谈、认知测试和注意力测试。其中，根据以下信息判断255人患有痴呆症：既往痴呆诊断及其准确性、CT扫描结果、简易精神状态检查表（MMSE）测试、临床痴呆评定量表（CDR）测试和DSM-IV标准。对每位患者记录两周内的精神和行为症状。

结果

在这两种环境中，痴呆患者的精神和行为症状都非常常见。总体而言，48%的患者出现精神病性症状（妄想、视幻觉或听幻觉、错误识别或偏执症状），43%有抑郁症状，26%有激越症状，26%有淡漠症状。精神药物的使用也很普遍：87%的患者至少服用一种精神药物，66%至少服用两种，36%至少服用三种，11%服用四种或更多精神药物。在痴呆患者中，42%服用传统抗精神病药物，34%服用抗焦虑药，尽管已知这些药物有副作用。只有13%的患者服用非典型抗精神病药物，3%服用胆碱酯酶抑制剂。选择性5-羟色胺再摄取抑制剂（SSRI）在患者中使用也很普遍（31%）。一个令人惊讶的发现是，具有抗胆碱能作用的药物使用也很频繁（20%）。