Farmakoterapia zaburzeń behawioralnych towarzyszących otępieniu

• Authors: Tomasz Sobów

Title variants

EN

Pharmacotherapy of behavioural disorders associated with dementia

• Languages of publication: PL

Abstracts

PL

Farmakoterapia zaburzeń zachowania i objawów neuropsychiatrycznych u chorych otępiałych (behavioural and psychological symptoms of dementia, BPSD) była przedmiotem wielu badań klinicznych. Ich wyniki nie pozwa­lają niestety na sformułowanie prostych zaleceń. Leki przeciwpsychotyczne (zwłaszcza II generacji) okazały się względnie skuteczne w zwalczaniu pobudzenia i agresji, ale ich działanie na objawy psychotyczne jest wątpliwe. Poważne obawy dotyczące bezpieczeństwa stosowania leków przeciwpsychotycznych (zwłaszcza ryzyko ostrych zdarzeń sercowo-mózgowych i związanej z nimi śmiertelności) w znaczący sposób ograniczają ich wykorzystanie. Leki przeciwdepresyjne, szczególnie z grupy selektywnych inhibitorów zwrotnego wychwytu serotoniny (selective serotonin reuptake inhibitor, SSRI), wykazują podobną skuteczność w zwalczaniu pobudzenia i objawów psycho­tycznych jak leki przeciwpsychotyczne, co wobec lepszej tolerancji zachęca do ich szerszego stosowania. Inne grupy leków (w tym przeciwdrgawkowe i benzodiazepiny), pomimo teoretycznych przesłanek sugerujących możliwą sku­teczność, w randomizowanych badaniach nie zostały ocenione jako wystarczająco efektywne (i bezpieczne), aby rekomendować ich szersze wykorzystanie. Rutynowe stosowanie zasady hierarchicznego postępowania w BPSD (najpierw staranna diagnostyka, w tym wykluczenie majaczenia, następnie interwencje niefarmakologiczne i opty­malizacja leczenia inhibitorami cholinesterazy i/lub memantyną, a dopiero w trzeciej kolejności zastosowanie leków psychotropowych) pozwala na ograniczenie farmakoterapii w tej szczególnie wrażliwej grupie pacjentów.

EN

Pharmacotherapy of behavioural and psychological symptoms of dementia (BPSD) has been studied in numer­ous clinical trials. Their results, however, are inconclusive and do not allow simple recommendations applicable for majority of patients. Antipsychotics (including atypicals) has been proved effective for agitation and aggres­sion, with doubtful effectiveness against delusions and hallucinations. Moreover, their efficacy is counterbalanced by safety concerns that include cerebrovascular events and related mortality. Antidepressants, particularly selec­tive serotonin reuptake inhibitors (SSRIs), are similarly to antipsychotics effective for agitation and psychosis; this is encouraging for their wider use considering their better safety profile. Other drugs, including antiepileptics and benzodiazepines, are poorly studied to date and both their effectiveness and safety are questionable. Hierarchical clinical management of BPSD is recommended for routine practice. In this model psychotropics are allowed only after careful diagnostic process (including exclusion of delirium) and employment of non-pharmacologic interven­tions coupled with optimal use of cholinesterase inhibitors and/or memantine.

Keywords

EN

atypical antipsychotics; atypowe leki przeciwpsychotyczne; behavioural disturbances; dementia; farmakoterapia; inhibitorywychwytu zwrotnego serotoniny; otępienie; pharmacotherapy; selective serotonin reuptake inhibitors; zaburzenia zachowania

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Aktualności Neurologiczne
• Year: 2013
• Volume: 13
• Issue: 4
• Pages: 295–301

Contributors

author

Tomasz Sobów

• Zakład Psychologii Lekarskiej, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Łodzi

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• Document Type: article