Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, The Netherlands; Laurens Care Centers, Rotterdam, The Netherlands.
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, The Netherlands.
J Am Med Dir Assoc. 2018 Mar;19(3):276.e1-276.e9. doi: 10.1016/j.jamda.2017.12.100.
Dementia is often accompanied by neuropsychiatric symptoms. Psychotropic drugs for the treatment of neuropsychiatric symptoms are frequently used to manage these problems, but they are of limited effectiveness and can have serious side effects. Psychosocial interventions are advocated as first line treatment and may help to reduce psychotropic drug use.
To assess the effect of multidisciplinary psychosocial interventions in nursing homes on the psychotropic drug prescription rate.
Literature obtained from searches in 9 electronic databases was systematically reviewed. In addition, the pooled effects of specific psychosocial interventions in homogenous subgroups were analyzed (meta-analysis).
Eleven randomized controlled studies that investigated multiple psychotropic drugs interventions (psychotropic drugs in 3, antipsychotics in 9, and antidepressants in 5 studies) as well as different types of psychosocial interventions were included. We separately analyzed interventions directed at the care staff level (educational programs in 3, in-reach services or consultation in 1, cultural or process change in 6 studies) and the individual resident level in 1 study. In 7 out of 9 studies reporting on antipsychotic drug use, the physician was actively involved. Nine studies in which antipsychotic drug use was specified reported a significant decrease in prescription rate as a result of psychosocial interventions [relative risk (RR) 0.71, 95% confidence interval (CI) 0.59-0.88], whereas meta-analysis of 5 studies investigating antidepressant drug use failed to show a significant effect (RR 0.82, 95% CI 0.64-1.02). Pooled effect sizes of 6 studies investigating cultural change, showed a significant decrease in antipsychotic drug use (RR 0.65, 95% CI 0.57-0.73). Effect sizes of 2 studies on educational programs on antipsychotic use were nonsignificant (RR 1.50, 95% CI 0.49-4.64). Sensitivity analysis of 7 studies reporting on antipsychotic drug use involving prescribing physicians showed a more robust decrease (RR 0.66, 95% CI 0.54-0.80).
The results of this study show that psychosocial interventions may lead to a substantial reduction of antipsychotic drug prescription, especially in studies that reported on cultural change and that involved prescribing physicians. Conspicuously, a profound lack of information was observed in many studies as to what exactly constituted the care-as-usual treatment in the control group.
痴呆症常伴有神经精神症状。常使用精神药物治疗神经精神症状来控制这些问题，但效果有限，且有严重的副作用。提倡使用社会心理干预作为一线治疗方法，这可能有助于减少精神药物的使用。
评估疗养院多学科社会心理干预对精神药物处方率的影响。
系统综述了从 9 个电子数据库中检索到的文献。此外，还分析了同质亚组中特定社会心理干预的汇总效果（荟萃分析）。
纳入了 11 项随机对照研究，这些研究调查了多种精神药物干预措施（3 项研究涉及多种精神药物，9 项研究涉及抗精神病药物，5 项研究涉及抗抑郁药物）以及不同类型的社会心理干预措施。我们分别分析了针对护理人员层面的干预措施（3 项教育项目、1 项上门服务或咨询、6 项文化或流程改变研究）和针对个体居民层面的干预措施。在报告抗精神病药物使用情况的 9 项研究中有 7 项研究中，医生积极参与其中。9 项明确报告抗精神病药物使用情况的研究报告称，社会心理干预导致处方率显著下降[相对风险（RR）0.71，95%置信区间（CI）0.59-0.88]，而 5 项抗抑郁药物使用研究的荟萃分析未能显示出显著效果（RR 0.82，95% CI 0.64-1.02）。对 6 项文化改变研究的汇总效应大小表明，抗精神病药物的使用显著减少（RR 0.65，95% CI 0.57-0.73）。2 项关于抗精神病药物使用教育项目的研究的效应大小无统计学意义（RR 1.50，95% CI 0.49-4.64）。对 7 项报告涉及处方医生的抗精神病药物使用的研究进行敏感性分析显示，抗精神病药物处方显著减少（RR 0.66，95% CI 0.54-0.80）。
这项研究的结果表明，社会心理干预可能会导致抗精神病药物处方的大量减少，尤其是在报告文化改变且涉及处方医生的研究中。值得注意的是，许多研究中明显缺乏关于对照组中常规治疗的确切信息。
