Pollock Bruce G, Mulsant Benoit H, Rosen Jules, Mazumdar Sati, Blakesley Richard E, Houck Patricia R, Huber Kimberly A
Rotman Research Institute at Baycrest, Toronto, Ontario, Canada.
Am J Geriatr Psychiatry. 2007 Nov;15(11):942-52. doi: 10.1097/JGP.0b013e3180cc1ff5. Epub 2007 Sep 10.
To compare citalopram and risperidone for the treatment of psychotic symptoms and agitation associated with dementia, with a priori hypotheses that risperidone would be more efficacious for psychosis and citalopram for agitation.
A 12-week randomized, controlled trial in nondepressed patients with dementia hospitalized because of behavioral symptoms (N = 103) was conducted at the University of Pittsburgh Medical Center. Participants were consecutively recruited on an inpatient unit if they had at least one moderate to severe target symptom (aggression, agitation, hostility, suspiciousness, hallucinations, or delusions). Once they improved sufficiently, they were discharged to nursing homes, personal care homes, or residential homes for continued treatment. Planned pre-post and mixed model analyses of the main outcome measures of Neurobehavioral Rating Scale and Side Effect Rating Scale at baseline and at weekly/biweekly intervals were conducted.
Completion rates did not differ for citalopram and risperidone (overall completion rate: 44%). Agitation symptoms (aggression, agitation, or hostility) and psychotic symptoms (suspiciousness, hallucinations, or delusions) decreased in both treatment groups but the improvement did not differ significantly between the two groups. There was a significant increase in side effect burden with risperidone but not with citalopram such that the two groups differed significantly.
No statistical difference was found in the efficacy of citalopram and risperidone for the treatment of either agitation or psychotic symptoms in patients with dementia. These findings need to be replicated before citalopram or other serotonergic antidepressants can be recommended as alternatives to antipsychotics for the treatment of agitation or psychotic symptoms associated with dementia.
比较西酞普兰和利培酮治疗与痴呆相关的精神病性症状和激越，预先假设利培酮对精神病更有效，而西酞普兰对激越更有效。
在匹兹堡大学医学中心对因行为症状住院的非抑郁性痴呆患者（N = 103）进行了一项为期12周的随机对照试验。如果参与者至少有一项中度至重度目标症状（攻击行为、激越、敌意、猜疑、幻觉或妄想），则在住院部连续招募。一旦他们病情充分改善，就出院到疗养院、个人护理院或养老院继续治疗。对基线时以及每周/每两周间隔的神经行为评定量表和副作用评定量表的主要结局指标进行了计划的前后分析和混合模型分析。
西酞普兰和利培酮的完成率没有差异（总体完成率：44%）。两个治疗组的激越症状（攻击行为、激越或敌意）和精神病性症状（猜疑、幻觉或妄想）均有所减轻，但两组之间的改善没有显著差异。利培酮组的副作用负担显著增加，而西酞普兰组没有，因此两组有显著差异。
在治疗痴呆患者的激越或精神病性症状方面，西酞普兰和利培酮的疗效没有统计学差异。在推荐西酞普兰或其他5-羟色胺能抗抑郁药作为抗精神病药物治疗与痴呆相关激越或精神病性症状的替代药物之前，这些发现需要重复验证。
