Nijk Renate M, Zuidema Sytse U, Koopmans Raymond T C M
Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
Int Psychogeriatr. 2009 Jun;21(3):485-93. doi: 10.1017/S1041610209008916. Epub 2009 Apr 16.
Neuropsychiatric symptoms in dementia patients are common and are often treated with psychotropic drugs. The aim of this study was to determine the prevalence and correlates of psychotropic drug use in Dutch nursing home patients with dementia.
Psychotropic drug use of 1322 patients on 59 dementia special care units (SCUs) in 25 nursing homes was registered. Drugs were categorized according to the Anatomical Therapeutical Chemical classification (ATC). The influence of age, gender, dementia stage measured by the Global Deterioration Scale (GDS), and type of neuropsychiatric symptoms on psychotropic drug use was analyzed using binomial logistic regression analysis.
63% of the patients used at least one psychotropic drug. Psychotropics in general and antipsychotics in particular were most frequently prescribed in GDS stage 6, and in patients aged between 65 and 75 years. Psychotropics in general were positively associated with depression, night-time behavior and agitation. Antipsychotic drug use was positively associated with psychosis, agitation and night-time behavior and was negatively associated with apathy. Anxiolytics were associated with age, psychosis, agitation and night-time behavior. Antidepressants were most frequently prescribed in GDS stage 6 and associated with female gender, agitation and depression. Sedatives were only associated with night-time behavior.
Nursing home patients with dementia have a high prevalence of psychotropic drug use. In particular, the association with neuropsychiatric symptoms raises questions of efficacy of these drugs and the risk of chronic use.
痴呆患者的神经精神症状很常见，且常使用精神药物进行治疗。本研究的目的是确定荷兰养老院痴呆患者中精神药物使用的患病率及其相关因素。
对25所养老院中59个痴呆特殊护理单元（SCU）的1322名患者的精神药物使用情况进行了登记。药物根据解剖治疗化学分类（ATC）进行分类。使用二项逻辑回归分析年龄、性别、用全球衰退量表（GDS）测量的痴呆阶段以及神经精神症状类型对精神药物使用的影响。
63%的患者使用了至少一种精神药物。一般精神药物，尤其是抗精神病药物，在GDS 6期以及65至75岁的患者中处方最为频繁。一般精神药物与抑郁、夜间行为和激越呈正相关。抗精神病药物的使用与精神病、激越和夜间行为呈正相关，与冷漠呈负相关。抗焦虑药与年龄、精神病、激越和夜间行为有关。抗抑郁药在GDS 6期处方最为频繁，与女性、激越和抑郁有关。镇静剂仅与夜间行为有关。
养老院痴呆患者精神药物使用率很高。特别是，与神经精神症状的关联引发了对这些药物疗效以及长期使用风险的质疑。
