《加拿大老年人苯二氮䓬受体激动剂使用障碍指南》标题
Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults Title.
作者信息
Conn David K, Hogan David B, Amdam Lori, Cassidy Keri-Leigh, Cordell Peter, Frank Christopher, Gardner David, Goldhar Morris, Ho Joanne M-W, Kitamura Christopher, Vasil Nancy
机构信息
Baycrest Health Sciences, North York, ON.
Department of Psychiatry, University of Toronto, Toronto, ON.
出版信息
Can Geriatr J. 2020 Mar 30;23(1):116-122. doi: 10.5770/cgj.23.419. eCollection 2020 Mar.
Abstract
BACKGROUND
Benzodiazepine receptor agonist (BZRA) use disorder among older adults is a relatively common and challenging clinical condition.
METHOD
The Canadian Coalition for Seniors' Mental Health, with financial support from Health Canada, has produced evidence-based guidelines on the prevention, identification, assessment, and management of this form of substance use disorder.
RESULTS
Inappropriate use of BZRAs should be avoided by considering non-pharmacological approaches to the management of late life insomnia, anxiety, and other common indications for the use of BZRA. Older persons should only be prescribed BZRAs after they are fully informed of alternatives, benefits, and risks associated with their use. Clinicians should have a high index of suspicion for the presence of BZRA use disorders. The full version of these guidelines can be accessed at www.ccsmh.ca.
CONCLUSIONS
A person-centred, stepped care approach utilizing gradual dose reductions should be used in the management of BZRA use disorder.
摘要
背景
老年人苯二氮䓬受体激动剂（BZRA）使用障碍是一种相对常见且具有挑战性的临床病症。
方法
加拿大老年人心理健康联盟在加拿大卫生部的资金支持下，制定了关于这种物质使用障碍的预防、识别、评估和管理的循证指南。
结果
应通过考虑采用非药物方法来管理老年失眠、焦虑以及使用BZRA的其他常见适应症，避免不适当使用BZRA。老年人在充分了解使用BZRA的替代方法、益处和风险后，才可开具此类药物。临床医生应对BZRA使用障碍的存在保持高度怀疑。这些指南的完整版本可在www.ccsmh.ca上获取。
结论
在管理BZRA使用障碍时，应采用以人为本的逐步护理方法，逐步减少剂量。
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J Am Geriatr Soc. 2019 Apr;67(4):674-694. doi: 10.1111/jgs.15767. Epub 2019 Jan 29.
2
Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults: The D-PRESCRIBE Randomized Clinical Trial.药师主导的教育干预对老年人不合理用药处方的影响：D-PRESCRIBE 随机临床试验。
JAMA. 2018 Nov 13;320(18):1889-1898. doi: 10.1001/jama.2018.16131.
3
Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline.苯二氮䓬类受体激动剂的撤药：基于证据的临床实践指南。
Can Fam Physician. 2018 May;64(5):339-351.
4
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Ther Adv Psychopharmacol. 2018 Mar;8(3):99-114. doi: 10.1177/2045125317743651. Epub 2017 Dec 5.
5
European guideline for the diagnosis and treatment of insomnia.欧洲失眠症诊断与治疗指南。
J Sleep Res. 2017 Dec;26(6):675-700. doi: 10.1111/jsr.12594. Epub 2017 Sep 5.
6
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7
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