Tampi Rajesh R, Tampi Deena J
Am J Alzheimers Dis Other Demen. 2014 Nov;29(7):565-74. doi: 10.1177/1533317514524813.
The objective of this review is to summarize the available data on the use of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia (BPSD) from randomized controlled trials (RCTs). A systematic search of 5 major databases, PubMed, MEDLINE, PsychINFO, EMBASE, and Cochrane Collaboration, yielded a total of 5 RCTs. One study compared diazepam to thioridazine, 1 trial compared oxazepam to haloperidol and diphenhydramine, 1 trial compared alprazolam to lorazepam, 1 trial compared lorazepam to haloperidol, and 1 trial compared intramuscular (IM) lorazepam to IM olanzapine and placebo. The data indicates that in 4 of the 5 studies, there was no significant difference in efficacy between the active drugs to treat the symptoms of BPSD. One study indicated that thioridazine may have better efficacy than diazepam for treating symptoms of BPSD. In 1 study, the active drugs had greater efficacy in treating BPSD when compared to placebo. There was no significant difference between the active drugs in terms of tolerability. However, in 2 of the 5 studies, about a third of the patients were noted to have dropped out of the studies. Available data, although limited, do not support the routine use of benzodiazepines for the treatment of BPSD. But these drugs may be used in certain circumstances where other psychotropic medications are unsafe for use in individuals with BPSD or when there are significant medication allergies or tolerability issues with certain classes of psychotropic medications.
本综述的目的是总结来自随机对照试验(RCT)的关于使用苯二氮䓬类药物治疗痴呆的行为和心理症状(BPSD)的现有数据。对5个主要数据库——PubMed、MEDLINE、PsychINFO、EMBASE和Cochrane协作网进行系统检索,共得到5项随机对照试验。1项研究比较了地西泮与硫利达嗪,1项试验比较了奥沙西泮与氟哌啶醇及苯海拉明,1项试验比较了阿普唑仑与劳拉西泮,1项试验比较了劳拉西泮与氟哌啶醇,1项试验比较了肌内注射(IM)劳拉西泮与IM奥氮平和安慰剂。数据表明,在5项研究中的4项里,活性药物在治疗BPSD症状方面的疗效没有显著差异。1项研究表明,硫利达嗪在治疗BPSD症状方面可能比地西泮疗效更好。在1项研究中,活性药物与安慰剂相比,在治疗BPSD方面有更高的疗效。活性药物在耐受性方面没有显著差异。然而,在5项研究中的2项里,约三分之一的患者被记录为退出研究。现有数据虽然有限,但不支持常规使用苯二氮䓬类药物治疗BPSD。但在某些情况下,当其他精神药物对患有BPSD的个体使用不安全,或当某些类别的精神药物存在严重的药物过敏或耐受性问题时,这些药物可能会被使用。
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