Niefarmakologiczne strategie postępowania w zaburzeniach zachowania towarzyszących otępieniu

• Authors: Monika Ponichtera-Kasprzykowska , Krzysztof Pękala , Tomasz Sobów

Title variants

EN

Non-pharmacological strategies of behavioural symptoms associated with dementia management

• Languages of publication: PL

Abstracts

PL

Zaburzenia zachowania i objawy psychotyczne dotyczą większości chorych otępiałych i stanowią poważny pro­blem nie tylko z powodu trudności związanych z opieką i cierpienia opiekunów, ale także niekorzystnych na­stępstw dla chorych, takich jak szybsza progresja dysfunkcji poznawczych, zwiększona potrzeba opieki i wcze­śniejsza instytucjonalizacja, ryzyko upadków i urazów oraz wyższa śmiertelność. Powszechnie stosowane leki (przeciwpsychotyczne, przeciwdepresyjne, przeciwpadaczkowe) cechuje ograniczona skuteczność, występują również problemy z tolerancją, a w przypadku leków przeciwpsychotycznych dodatkowe ryzyko powikłań ze strony układu krążenia i przedwczesnych zgonów. Alternatywą mogą być interwencje niefarmakologiczne, które są względnie dobrze przebadane, cechują się zadowalającą efektywnością wobec przynajmniej niektórych obja­wów behawioralnych (zwłaszcza pobudzenia, zaburzeń nastroju, zaburzeń snu i apatii) oraz zdecydowanie lep­szym bezpieczeństwem stosowania niż jakiekolwiek leki. Stosowane podejścia opierają się na czterech mode­lach teoretycznych (genetyczno-biologiczny, behawioralny, nadwrażliwości na stres i niezaspokojonych potrzeb), z których wywodzi się specyficzne interwencje, dostosowane do potrzeb chorych z demencją. Do najlepiej prze­badanych należą interwencje sensoryczne, ustrukturowane aktywności i metody potencjalizowania kontaktów społecznych. Powszechnie stosowane są także różne interwencje behawioralne, które są jednak niewystarcza­jąco dokładnie przebadane. Wdrożenie metod niefarmakologicznych utrudniają przyzwyczajenia i przekonania oraz inne bariery mentalne, niewiedza personelu fachowego i opiekunów, a także bariery związane z systemem ochrony zdrowia i wysokimi kosztami opieki.

EN

Behavioural and psychological symptoms of dementia (BPSD) are common among demented patients and con­stitute a serious problem not only because of additional care-related issues and increased caregivers’ burden, but also due to considerable consequences for the patients, including faster progression of cognitive disorder, in­creased care need and earlier institutionalization, risk of falls and injuries as well as increased mortality. Com­monly used drugs (antipsychotics, antidepressants, antiepileptic) have limited efficacy and tolerability. Moreover, antipsychotics use in dementia has been linked to increased risk of cerebrovascular events (like stroke and myocar­dial infarct) and premature mortality. Non-pharmacological interventions have been proposed as an alternative to drug use. Their efficacy, although also limited, is not inferior to drugs while the risk of side effects is minimal as compared to any drug. Four different theoretical models (genetic-biological, behavioural, stress hypersensitiv­ity and frustrated needs) are used for the development of different management approaches. The resulting, clini­cally confirmed methods include sensory interventions, structured activities and social activities potentialization. The commonly used behavioural methods, although popular, are surprisingly insufficiently examined in clinical trials. Wider use of non-pharmacological methods for dementia (including BPSD) is compromised by mental bar­riers of health professionals (including beliefs and habits), low level of knowledge among professionals and care­givers as well as barriers related to health care system and costs of care.

Keywords

EN

behavioural symptoms; dementia; interwencje niefarmakologiczne; needs; non-pharmacological interventions; otępienie; potrzeby; stres; stress; zaburzenia zachowania

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Aktualności Neurologiczne
• Year: 2013
• Volume: 13
• Issue: 4
• Pages: 302–307

Contributors

author

Monika Ponichtera-Kasprzykowska

• Studium Doktoranckie Uniwersytetu Medycznego w Łodzi

author

Krzysztof Pękala

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

author

Tomasz Sobów

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

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• Document Type: article