Paul Sabatier University, Department of Psychiatry and Medical Psychology, Purpan-Casselardit Hospital, Toulouse, France.
Int Psychogeriatr. 2010 Feb;22(1):120-8. doi: 10.1017/S1041610209990780. Epub 2009 Sep 7.
Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription.
REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI).
A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI >or= 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression.
The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.
在临床实践中，精神药物被广泛用于治疗阿尔茨海默病（AD）患者的行为和心理症状（BPSD）。然而，对于 AD 患者中抗抑郁药的实际使用情况，仅有少数药物流行病学研究或自然环境下的研究。本调查旨在评估 AD 患者中使用抗抑郁药的流行率，并确定与抗抑郁药处方相关的临床因素。
REAL.FR 是一项为期四年的前瞻性多中心研究。获得了包括人口统计学特征、临床变量和药物摄入在内的基线数据。使用神经精神病学问卷（NPI）确定抑郁症状。
共纳入 686 例 AD 患者。为 34.8%的患者开具了抗抑郁治疗处方。在总人群中，观察到 20.5%的患者存在临床显著抑郁症状（NPI≥4）。尽管有抑郁症状的患者比无抑郁症状的患者更有可能接受抗抑郁治疗（p<0.0001），但总体而言，只有 60%的抑郁患者开具了抗抑郁药。在多变量分析中，临床显著抑郁症状与抗抑郁药处方相关，尽管这一结果仅在无既往抑郁史的患者中观察到。
除抑郁（特别是激越、攻击，偶尔还有精神病症状）以外，有关 BPSD 中抗抑郁药疗效的现有数据并不影响处方选择。在没有既往抑郁史的情况下，抑郁症状可能会受到更严重的对待，导致首次出现抑郁症状的个体的抗抑郁药处方率增加。
