Herrmann N, Lanctôt K L
University of Toronto, Ontario.
Can J Psychiatry. 1997 Jun;42 Suppl 1:51S-64S.
Behavioural disturbances in dementia are a common cause of excess morbidity, impairing the quality of life for both patient and caregiver. As part of a comprehensive approach to management, which includes a search for underlying causes and behavioural interventions, pharmacotherapy can be extremely helpful in alleviating symptoms such as agitation, aggression, and psychosis.
This paper reviews recent studies that examine the neurochemical basis of these behavioural disturbances in order to provide a rationale for the various classes of psychotropics which have been used.
While neuroleptics have been the best-studied class of drugs to date, modest efficacy and significant potential side effects often limit their use. Newer atypical neuroleptics may be better tolerated, though controlled data have yet to be published. There is increasing support of the use of carbamazepine and antidepressants such as trazodone and the selective serotonin reuptake inhibitors (SSRIs).
Further controlled studies of all of these agents are required. In order to determine whether transmitter-specific or behavioural-specific targeted interventions truly provide a rationale for the effective pharmacotherapy of these disorders.
痴呆中的行为障碍是发病率过高的常见原因，会损害患者和照料者的生活质量。作为综合管理方法的一部分，包括寻找潜在病因和行为干预，药物治疗在缓解激越、攻击和精神病等症状方面可能非常有帮助。
本文综述了近期研究，这些研究探讨了这些行为障碍的神经化学基础，以便为已使用的各类精神药物提供理论依据。
虽然抗精神病药物是迄今为止研究最多的一类药物，但疗效一般且潜在副作用较大常常限制了它们的使用。新型非典型抗精神病药物的耐受性可能更好，不过对照数据尚未公布。越来越多的人支持使用卡马西平和抗抑郁药，如曲唑酮和选择性5-羟色胺再摄取抑制剂（SSRI）。
需要对所有这些药物进行进一步的对照研究。以确定递质特异性或行为特异性靶向干预是否真的为这些疾病的有效药物治疗提供理论依据。
