Zaburzenia psychiczne w przebiegu zespołów otępiennych – znaczenie kliniczne i zasady postępowania

• Authors: Tomasz Sobów

Title variants

EN

Psychiatric disorders coexisting with dementia – clinical relevance and principles of management

• Languages of publication: PL

Abstracts

PL

Zaburzenia psychiczne (psychozy, depresje, zaburzenia lękowe) oraz inne objawy behawioralne i psychologiczne (behavioural and psychological symptoms of dementia, BPSD) są powszechne u chorych z otępieniami, niezależnie od ich domniemanej etiologii. Spotyka się je nawet w fazach prodromalnych otępień, a nasilenie i rozpowszechnienie wielu z nich narasta wraz z progresją dysfunkcji poznawczych. Występowanie BPSD wiąże się z szeregiem negatywnych konsekwencji zarówno dla pacjenta, jak i jego opiekunów. Obecność objawów psychotycznych pogarsza naturalny przebieg demencji, powodując szybsze narastanie deficytów poznawczych, wzrost liczby hospitalizacji oraz ryzyka umieszczenia w placówce opiekuńczej i śmiertelności, większe nasilenie funkcjonalnej niesprawności, jak również jednoznacznie udokumentowane pogorszenie funkcjonowania opiekunów i wzrost ryzyka wystąpienia u nich zaburzeń psychicznych, zwłaszcza depresyjnych. Leczenie BPSD jest trudne, nie opracowano dotąd powszechnie akceptowanego standardu, skutecznego u większości pacjentów. Zaleca się wdrożenie metod niefarmakologicznych praktycznie u wszystkich pacjentów, istotną rolę odgrywa także edukacja opiekunów. Kluczowe dla powodzenia terapii jest optymalne dawkowanie leków prokognitywnych, inhibitorów cholinesterazy i memantyny. Leki psychotropowe mają ograniczoną skuteczność i mogą powodować poważne objawy niepożądane. Szczególnej ostrożności wymaga stosowanie leków przeciwpsychotycznych, które, choć czasami niezbędne, zwiększają ryzyko przedwczesnego zgonu – mogą wywoływać incydenty sercowo-mózgowe. Leki przeciwdepresyjne są relatywnie mało skuteczne w leczeniu depresji i zaburzeń lękowych, natomiast mogą być pomocne w leczeniu pobudzenia, agresji i psychozy, co udokumentowano zwłaszcza w przypadku citalopramu i trazodonu.

EN

Psychiatric disorders (including psychosis, depression and anxiety disorders) as well as other behavioural and psychological symptoms of dementia (collectively referred to as BPSD) are common in the demented, regardless of presumed aetiology of dementia. They may appear even at the prodromal phase of dementia, while severity and incidence of many of them increases with progression of cognitive dysfunction. Development of BPSD is associated with several negative consequences, both for the patient and his/her caregivers. Presence of psychotic symptoms affects unfavourably further course of dementia, accelerating cognitive decline, increased number of hospitalizations, risk of institutionalization and mortality as well as greater degree of functional disability. A well-documented phenomenon correlated therewith isincreased caregivers’ burden and increased risk of caregivers’ psychiatric problems, including depression. Treatment of BPSD is difficult and no uniformly accepted and universally effective management standard or guidelines have been proposed to date. Non-pharmacological approach is considered obligatory for most patients, while education of caregivers or institution personnel is paramount. The key issue is optimal dosage of anti-dementia drugs, including cholinesterase inhibitors and memantine. Efficacy of psychotropic drugs is largely limited and their clinical usefulness compromised by poor side effects profile of many of them. Particular care must be paid when using antipsychotics due to presumed risk of premature death secondary to cerebrovascular complications. Antidepressants, though relatively ineffective in treating depression and anxiety, might be an option in patients with agitation, aggression and psychosis as documented to date in the case of citalopram and trazodone.

Keywords

EN

Alzheimer’s disease; anticonvulsants; antidepressants; antipsychotics; behavioural disorders; choroba Alzheimera; dementia; leczenie; leki przeciwdepresyjne; leki przeciwpadaczkowe; leki przeciwpsychotyczne; otępienie; psychiatric disorders; treatment; zaburzenia psychiczne; zaburzenia zachowania

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Aktualności Neurologiczne
• Year: 2012
• Volume: 12
• Issue: 4
• Pages: 236–244

Contributors

author

Tomasz Sobów

• Zakład Psychologii Lekarskiej, Uniwersytet Medyczny w Łodzi

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