Department of Old Age Psychiatry, University Hospital of Psychiatry, Murtenstrasse, Bern, CH.
Swiss Med Wkly. 2011 Oct 4;141:w13254. doi: 10.4414/smw.2011.13254. eCollection 2011.
Psychotropic medication is commonly used in nursing homes, to treat behavioural and psychological symptoms of dementia (BPSD) for example. Treatment with antipsychotics may improve BPSD in some residents but can be associated with serious side effects, such as higher mortality, faster disease progression and cerebrovascular events. In the current study, psychotropic medication use was analysed in a representative sample of nursing home residents in the German-speaking part of Switzerland, at entry and during follow-up.
Retrospective analysis of the Resident Assessment Instrument Minimum Data Set (RAI-MDS) of 90 nursing homes at entry (n = 18853) and during follow-up (n = 12101).
At entry, 7580 residents (40.2%) were diagnosed with dementia and 49.0% of them had behavioural symptoms. Residents with dementia received more psychotropic medication than residents without dementia (70.8% vs. 55.0%; p<0.001). The most commonly prescribed medications were antipsychotics (demented 44.8% vs. non-demented 17.4%; p<0.001) and antidepressants (demented 29.6% vs. non-demented 26.7%; p<0.001). Antipsychotics were mainly prescribed for residents with dementia and behavioural disturbances. The longitudinal analysis revealed that most residents with dementia (69.5%) took antipsychotics continuously from entry to the final assessment and the same was true for antidepressants (66.1%). The use of antipsychotics at baseline in residents with dementia predicted (p<0.001) the use of antipsychotics during follow-up.
The long term use of antipsychotics in nursing homes may need to be reconsidered in view of novel treatment recommendations, suggesting that the prescription of antipsychotics for patients with dementia should be a second line treatment, restricted to symptoms of psychosis or severe aggression, and prescribed for the shortest duration possible.
精神药物在养老院中被广泛使用，例如用于治疗痴呆患者的行为和心理症状（BPSD）。抗精神病药物的治疗可能会改善一些患者的 BPSD，但也可能会导致严重的副作用，如更高的死亡率、更快的疾病进展和脑血管事件。在目前的研究中，对瑞士德语区的一个有代表性的养老院居民样本进行了精神药物使用分析，包括入院时和随访期间。
对 90 家养老院的居民评估工具最低数据集（RAI-MDS）进行回顾性分析，共包括入院时（n=18853）和随访期间（n=12101）的数据。
入院时，7580 名居民（40.2%）被诊断为痴呆症，其中 49.0%的患者有行为症状。患有痴呆症的居民比没有痴呆症的居民接受更多的精神药物治疗（70.8%比 55.0%；p<0.001）。最常开的药物是抗精神病药物（痴呆症患者 44.8%，非痴呆症患者 17.4%；p<0.001）和抗抑郁药（痴呆症患者 29.6%，非痴呆症患者 26.7%；p<0.001）。抗精神病药物主要用于有痴呆和行为障碍的患者。纵向分析显示，大多数患有痴呆症的居民（69.5%）从入院到最终评估一直连续服用抗精神病药物，抗抑郁药也是如此（66.1%）。在患有痴呆症的患者中，基线时使用抗精神病药物预测（p<0.001）了随访期间使用抗精神病药物。
鉴于新的治疗建议，长期在养老院中使用抗精神病药物可能需要重新考虑，建议将抗精神病药物用于痴呆症患者应作为二线治疗，限于精神病或严重攻击行为，并尽可能缩短疗程。
