Passmore Michael J, Gardner David M, Polak Yvette, Rabheru Kiran
Department of Psychiatry, Division of Geriatric Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Drugs Aging. 2008;25(5):381-98. doi: 10.2165/00002512-200825050-00003.
Numerous recent studies have challenged the widely held belief that atypical antipsychotics are safe and effective options for the treatment of behavioural problems such as agitation in patients with dementia. Accordingly, there is a need to reconsider the place of atypical antipsychotics in the treatment of patients with dementia. The present article is intended to assist clinicians with the assessment and pharmacological management of agitation in patients with dementia. We review the risk-benefit evidence for the use of atypical antipsychotics in patients with dementia-related agitation (DRA). Emerging evidence indicates that, for patients with dementia, the risks associated with atypical antipsychotics may outweigh the benefits except for patients with severe agitation who require short-term chemical restraint. We then discuss the importance of a careful assessment to rule out potentially reversible factors contributing to DRA. Finally, we summarize the evidence supporting the use of medications other than antipsychotics to treat DRA. There is wide variability in the levels of evidence supporting the use of non-antipsychotic medication for the treatment of DRA. The best evidence currently exists for cholinesterase inhibitors and serotonin-specific reuptake inhibitor antidepressants. Emerging reports suggest that numerous other medications, for example, antiepileptics, lithium, anxiolytics, analgesics, beta-adrenoceptor antagonists, cannabinoid receptor agonists and hormonal agents, may prove to be viable alternatives to antipsychotics for the treatment of severe DRA and more research is urgently needed to help assess the effectiveness of these agents. A comprehensive biopsychosocial assessment and treatment plan is likely the most effective way to manage DRA.
近期众多研究对一种广泛持有的观点提出了挑战，该观点认为非典型抗精神病药物是治疗痴呆患者行为问题（如激越）的安全有效选择。因此，有必要重新审视非典型抗精神病药物在痴呆患者治疗中的地位。本文旨在帮助临床医生对痴呆患者的激越进行评估和药物管理。我们回顾了在痴呆相关激越（DRA）患者中使用非典型抗精神病药物的风险效益证据。新出现的证据表明，对于痴呆患者，非典型抗精神病药物的风险可能超过益处，但对于需要短期药物约束的严重激越患者除外。然后我们讨论仔细评估以排除导致DRA的潜在可逆因素的重要性。最后，我们总结了支持使用抗精神病药物以外的药物治疗DRA的证据。支持使用非抗精神病药物治疗DRA的证据水平存在很大差异。目前胆碱酯酶抑制剂和5-羟色胺特异性再摄取抑制剂类抗抑郁药的证据最为充分。新出现的报告表明，许多其他药物，例如抗癫痫药、锂盐、抗焦虑药、镇痛药、β肾上腺素能受体拮抗剂、大麻素受体激动剂和激素类药物，可能被证明是治疗严重DRA的抗精神病药物的可行替代方案，迫切需要更多研究来帮助评估这些药物的有效性。全面的生物心理社会评估和治疗计划可能是管理DRA最有效的方法。
