J Psychosoc Nurs Ment Health Serv. 2020 Aug 1;58(8):12-16. doi: 10.3928/02793695-20200722-01.
The drive to prescribe to alleviate symptoms and ease suffering is prevalent in health care. In psychiatry, it is no different. Although monotherapy remains the preferred approach to treating psychiatric disorders, especially when combined with nonpharmacological approaches, in practice, a focus on remission of symptoms over patient preferences and quality of life can result in higher doses than necessary and polypharmacy from the addition of drugs for augmentation or treatment of adverse effects. This is especially concerning for older adults who are likely to have comorbid medical disorders, eventually leading to prescribing cascades as different providers address different symptoms. Whereas we generally look to best practice guidelines to treat identified disorders, the approach to treating older adults with multimorbidities requires collaboration among the patient, the family (if appropriate), and the provider to re-evaluate goals based on the patient's priorities, and to examine tradeoffs, reduce medication overload, and simplify care. Fortunately, many resources are available to help the clinician in this process. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 12-16.].
在医疗保健中，缓解症状和减轻痛苦的治疗动机普遍存在。在精神病学中，情况也没有什么不同。尽管单药治疗仍然是治疗精神障碍的首选方法，尤其是与非药物治疗方法相结合时，但在实践中，关注症状缓解而不是患者的偏好和生活质量，可能会导致剂量过高，并因增效或治疗不良反应而添加药物导致药物的联合应用。对于可能患有合并症的老年人来说，这尤其令人担忧，最终会导致不同的提供者针对不同的症状进行处方级联。虽然我们通常会根据最佳实践指南来治疗已确定的疾病，但对于患有多种疾病的老年人，需要患者、家庭（如果适用）和提供者之间进行合作，根据患者的优先事项重新评估目标，并权衡利弊、减少药物负荷、简化护理。幸运的是，有许多资源可以帮助临床医生在这一过程中。[《精神科护理与心理健康服务杂志》，58(8)，12-16。]。
