Shimizu Yoshiro, Kazui Hiroaki, Sawa Yutaka, Takeda Masatoshi
Sawa Hospital.
Department of Psychiatry, Osaka University Graduate School of Medicine.
Seishin Shinkeigaku Zasshi. 2013;115(11):1113-21.
Neuropsychiatric symptoms and behavioral changes, known as behavioral and psychological symptoms of dementia (BPSD), are often observed in patients with dementia. BPSD impairs a patient's quality of life, increases the burden on the caregivers, and can be a predictor of the need for institutionalization. BPSD can aggravate on holidays or at night, when general psychiatric clinics are closed. When psychiatric symptoms aggravate on holidays or at night in patients with psychiatric disorders other than dementia, such as schizophrenia and manic psychosis, the patients visit psychiatric emergency hospitals. However, it has not been assessed whether patients with dementia visit psychiatric emergency hospitals for the treatment of BPSD on holidays or at night, although dementia patients are increasing and account for 10.5% of psychiatric outpatients in Japan.
To determine the percentage of dementia patients with BPSD in all psychiatric patients who visit psychiatric emergency hospitals, and the characteristics of patients with BPSD in Japan.
We developed two questionnaires. One was for psychiatric emergency hospitals and assessed the numbers of all patients, patients over 65 years old, and patients over 65 years and with BPSD or BPSD-like symptoms, who visited the psychiatric emergency hospitals on holidays or at night. The other questionnaire was for each patient over 65 years and with BPSD, and assessed the patients' characteristics, including their diagnosis, sex, what kinds of BPSD or BPSD-like symptoms brought them to the hospital, and whether they had visited a psychiatric clinic or hospital during the preceding 12 months. The questionnaires were sent to 360 hospitals that belong to the Japan Psychiatric Hospitals Association and treat patients with acute psychotic symptoms or dementia. This prospective survey was conducted from October 1 to November 30, 2009.
One hundred and forty-three hospitals returned the questionnaires (response rate: 39.7%). In the survey period, 3,527 patients visited the psychiatric emergency hospitals on holidays or at night, but only 67 patients over 65 years old (1.9%) visited the hospitals for BPSD or BPSD-like symptoms. Thirty-four of the 67 patients were men, and their average age was 79.4 +/- 6.4 years old. Thirty-five patients had visited but 25 patients had never visited psychiatric clinics or hospitals during the preceding 12 months. Eight patients had physical complications that required examination for several days, while 57 patients did not require such treatment. Forty-seven patients were diagnosed with dementia. Patients with Alzheimer's disease (AD) (29 patients) were the most common, followed by those with vascular dementia (VaD) (8 patients) and those with dementia with Lewy bodies (DLB) (4 patients). Among the 47 patients with dementia, agitation/aggression was the most frequent BPSD symptom (30 patients), followed by irritability (18 patients) and aberrant motor behaviors (17 patients). The BPSD symptoms observed at the psychiatric emergency hospitals differed due to the causative dementia. Agitation/aggression, aberrant motor behaviors, and irritability were the most frequent causative symptoms in AD, agitation/aggression and irritability were the most frequent causative symptoms in VaD, and hallucinations and illusions were the most frequent causative symptoms in DLB.
Our survey revealed that few patients over 65 years old visited psychiatric emergency hospitals for BPSD on holidays or at night in Japan, and that many of them had not regularly visit psychiatric clinics or dementia hospitals in the preceding 12 months. These results indicate that dementia patients need to visit their doctors regularly to avoid visiting psychiatric emergency hospitals on holidays or at night, and caregivers should be aware that they can visit psychiatric emergency hospitals for the treatment of BPSD on holidays or at night.
神经精神症状和行为改变，即痴呆的行为和心理症状（BPSD），在痴呆患者中经常出现。BPSD会损害患者的生活质量，增加护理人员的负担，并且可能是需要入住机构的一个预测因素。BPSD在节假日或夜间可能会加重，而此时普通精神科门诊是关闭的。对于患有精神分裂症和躁狂性精神病等非痴呆性精神障碍的患者，当精神症状在节假日或夜间加重时，他们会前往精神科急诊医院就诊。然而，尽管痴呆患者数量在增加且占日本精神科门诊患者的10.5%，但尚未评估痴呆患者是否会在节假日或夜间前往精神科急诊医院治疗BPSD。
确定在前往精神科急诊医院就诊的所有精神科患者中，患有BPSD的痴呆患者的比例，以及日本BPSD患者的特征。
我们编制了两份问卷。一份是针对精神科急诊医院的，评估在节假日或夜间前往精神科急诊医院就诊的所有患者、65岁以上患者以及65岁以上且有BPSD或类似BPSD症状的患者的数量。另一份问卷是针对每位65岁以上且有BPSD的患者，评估患者的特征，包括他们的诊断、性别、导致他们前来医院的BPSD或类似BPSD症状的类型，以及他们在之前12个月内是否去过精神科门诊或医院。问卷被发送给了360家属于日本精神病医院协会且治疗急性精神病症状或痴呆患者的医院。这项前瞻性调查于2009年10月1日至11月30日进行。
143家医院返回了问卷（回复率：39.7%）。在调查期间，有3527名患者在节假日或夜间前往精神科急诊医院就诊，但只有67名65岁以上的患者（1.9%）因BPSD或类似BPSD症状前往医院就诊。67名患者中有34名男性，他们的平均年龄为79.4±6.4岁。67名患者中有35名曾就诊过，但25名患者在之前12个月内从未去过精神科门诊或医院。8名患者有需要检查数天的身体并发症，而57名患者不需要此类治疗。47名患者被诊断为痴呆。阿尔茨海默病（AD）患者（29名）最为常见，其次是血管性痴呆（VaD）患者（8名）和路易体痴呆（DLB）患者（4名）。在47名痴呆患者中，激越/攻击行为是最常见的BPSD症状（30名患者），其次是易怒（18名患者）和异常运动行为（17名患者）。在精神科急诊医院观察到的BPSD症状因导致痴呆的病因不同而有所差异。激越/攻击行为、异常运动行为和易怒是AD中最常见的致病症状，激越/攻击行为和易怒是VaD中最常见的致病症状，幻觉和错觉是DLB中最常见的致病症状。
我们的调查显示，在日本，很少有65岁以上的患者在节假日或夜间因BPSD前往精神科急诊医院就诊，而且他们中的许多人在之前12个月内没有定期去精神科门诊或痴呆专科医院就诊。这些结果表明，痴呆患者需要定期就医，以避免在节假日或夜间前往精神科急诊医院，护理人员应该意识到他们可以在节假日或夜间前往精神科急诊医院治疗BPSD。
