The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia.
Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia.
Int J Geriatr Psychiatry. 2021 Sep;36(9):1299-1303. doi: 10.1002/gps.5545. Epub 2021 Apr 5.
The aetiopathogenesis of behaviours and psychological symptoms of dementia (BPSD) is often subjective, complex and multifaceted, produced by an array of contributing factors, including biomedical, psychological, environmental and/or social factors. Alongside other contributing factors, organic aetiology of BPSD should be considered when devising therapeutic management plans. Although considered last resort, time‐limited antipsychotic treatment (≤3 months) may have a vital adjunct role in managing intractable, refractory, distressing and/or life‐threatening BPSD, such as delusions and hallucinations; but only after person‐centred psychosocial interventions are exhausted and fail to deliver any therapeutic response. If prescribed, careful monitoring of therapeutic responses and adverse effects of antipsychotics with de‐prescribing plans should be a top priority, as these agents have limited efficacies and serious adverse outcomes (e.g., mortality).
痴呆患者行为和心理症状(BPSD)的病因学常常是主观的、复杂的和多方面的,由一系列促成因素产生,包括生物医学、心理、环境和/或社会因素。在制定治疗管理计划时,除其他促成因素外,还应考虑 BPSD 的器质性病因。尽管被认为是最后的手段,但限时抗精神病药物治疗(≤3 个月)在管理难以控制、难治性、痛苦和/或危及生命的 BPSD 方面可能具有重要的辅助作用,例如妄想和幻觉;但只有在以患者为中心的心理社会干预措施用尽且未能产生任何治疗反应时才使用。如果开处方,应高度优先考虑仔细监测抗精神病药物的治疗反应和不良反应,并制定减药计划,因为这些药物的疗效有限,且会产生严重的不良后果(例如死亡率)。