Devanand D P, Levy S R
Memory Disorders Center, Columbia University, New York, New York 10032, USA.
J Geriatr Psychiatry Neurol. 1995 Oct;8 Suppl 1:S18-27. doi: 10.1177/089198879500800104.
Neuroleptics remain the mainstay for the treatment of behavioral disturbance and psychotic symptoms in demented patients. The limited available data suggest that low-dose neuroleptics are significantly more efficacious than placebo, though the magnitude of the effect is moderate in most published studies. Demented patients are particularly prone to neuroleptic side effects, and individualized dose titration may be necessary to achieve the optimal trade-off between efficacy and side effects. Target behavioral symptoms and side effects, including effects on cognition and activities of daily life, should be identified and assessed serially during neuroleptic treatment. The choice of neuroleptic depends more on likely side effects than differential efficacy, and non-response or intolerable side effects should lead to dose adjustment or a switch to an alternative class of neuroleptic (or an alternative type of medication). Further studies of optimal neuroleptic dosage, the optimal duration of continuation neuroleptic treatment, and placebo-controlled studies comparing neuroleptics to other classes of medications are needed.
抗精神病药物仍然是治疗痴呆患者行为障碍和精神病症状的主要手段。有限的现有数据表明，低剂量抗精神病药物比安慰剂显著更有效，尽管在大多数已发表的研究中效果程度适中。痴呆患者特别容易出现抗精神病药物的副作用，可能需要进行个体化剂量滴定，以在疗效和副作用之间实现最佳平衡。在抗精神病药物治疗期间，应连续识别和评估目标行为症状及副作用，包括对认知和日常生活活动的影响。抗精神病药物的选择更多地取决于可能出现的副作用而非疗效差异，无反应或无法耐受的副作用应导致剂量调整或换用另一类抗精神病药物（或另一种类型的药物）。需要进一步研究抗精神病药物的最佳剂量、抗精神病药物持续治疗的最佳时长，以及将抗精神病药物与其他类药物进行比较的安慰剂对照研究。
