University of Chicago Medical Center, Department of Medicine, Chicago, Illinois.
University of Chicago Medical Center, Department of Psychiatry and Behavioral Neuroscience, Chicago, Illinois.
J Clin Psychiatry. 2023 Sep 18;84(6):23m14791. doi: 10.4088/JCP.23m14791.
Neuropsychiatric symptoms (NPS) of dementia represent a large driver of health care costs, caregiver burden, and institutionalization of people with dementia. Management options are limited, and antipsychotics are often used, although they carry a significant side effect profile. One novel option is tetrahydrocannabinol (THC); however, in the US, to obtain THC for patients with dementia, caregivers have to go to a commercial dispensary. We evaluated the effectiveness of dispensary-obtained THC for patients with dementia and NPS. Two independent reviewers reviewed charts of patients with diagnosed dementia (N = 50) seen in geriatric psychiatry between 2017 and 2021 for whom dispensary-obtained THC was recommended. The primary outcome was effectiveness in treating NPS; secondary outcomes were the proportion of caregivers who obtained and administered THC (uptake), post-THC antipsychotic use, and adverse reactions leading to treatment discontinuation. Caregiver uptake of dispensary-obtained THC was high (38/50, 76%). The majority of patients (30/38, 79%) who took THC had an improvement in NPS according to their caregivers. THC was recommended most often for the NPS of agitation, aggression, irritability, lability, anxiety, and insomnia. Among the 20 patients who were taking antipsychotics at baseline and took THC, over half (12/20, 60%) were able to decrease or discontinue the antipsychotic. Adverse reactions to THC included dizziness, worsening of agitation, and worsening of paranoia; two caregivers of patients who took THC reported adverse reactions that led to treatment discontinuation. Our results suggest that dispensary-obtained THC can be effective in managing a subset of NPS in patients with dementia and may decrease the requirement for antipsychotics.
神经精神症状（NPS）是痴呆症患者医疗费用、照料者负担和住院的主要驱动因素之一。管理选择有限，抗精神病药通常被使用，尽管它们具有显著的副作用。一种新的选择是四氢大麻酚（THC）；然而，在美国，为了让痴呆症患者获得 THC，照料者必须去商业药房。我们评估了从药房获得的 THC 对痴呆症和 NPS 患者的疗效。两名独立审查员审查了 2017 年至 2021 年期间在老年精神病学中就诊的诊断为痴呆症的患者（N=50）的图表，这些患者被推荐从药房获得 THC。主要结果是治疗 NPS 的效果；次要结果是获得和使用 THC 的照料者比例（使用率）、使用 THC 后抗精神病药的使用情况以及导致治疗中断的不良反应。从药房获得 THC 的照料者使用率很高（38/50，76%）。根据照料者的说法，大多数服用 THC 的患者（30/38，79%）的 NPS 有所改善。THC 最常被推荐用于治疗激越、攻击、易怒、情绪不稳定、焦虑和失眠等 NPS。在基线时服用抗精神病药并服用 THC 的 20 名患者中，超过一半（12/20，60%）能够减少或停止服用抗精神病药。THC 的不良反应包括头晕、激越加重和偏执加重；两名服用 THC 的患者的照料者报告了导致治疗中断的不良反应。我们的结果表明，从药房获得的 THC 可以有效治疗痴呆症患者的一部分 NPS，并且可能减少抗精神病药的需求。
