Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes:: Development of practice recommendations in a Swiss canton
Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes:: Development of practice recommendations in a Swiss canton
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DOI：
10.1016/j.jamda.2008.04.003
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发表时间：
2008-07-01
影响因子：
7.6
通讯作者：
Bugnon, Oliver
中科院分区：
文献类型：
--
作者：
Jean-Francois, Locca;Buela, Christophe J.;Bugnon, Oliver
目标：2002年，瑞士弗里堡州在疗养院实施协调药学护理服务，以促进合理用药。在这项服务的背景下，开展了一个项目，为疗养院居民痴呆症行为和心理症状（BPSD）的药物管理制定建议。设计和方法：系统地搜索和评估与痴呆症患者抑郁、失眠和激越管理相关的选定循证指南和荟萃分析来源。审查了有关最常见 BPSD 症状的药物治疗的证据和争议，并制定了治疗算法。结果：确定了 10 项基于证据的 BPSD 管理指南和荟萃分析，但没有一个专门解决与疗养院居民相关的问题。根据该文献，针对疗养院居民抑郁、睡眠障碍和躁动的药物管理实践提出了建议。对于抑郁症，如果需要抗抑郁药，SSRIs 被认为是首选。尚未发现睡眠障碍的明确证据；在采用任何药物治疗之前，需要仔细调查潜在的病症。许多药物已被研究用于治疗躁动，如有必要，可以使用抗精神病药物，尽管它们具有显着的副作用。确定了几个不确定领域，例如当前关于典型和非典型抗精神病药物的使用或胆碱酯酶抑制剂是否适合控制躁动的争议。治疗方案已提交给弗里堡州疗养院的全科医生、药剂师和医务主任，现在将通过教育课程、药物咨询和监测逐步实施。结论：根据现有的循证研究，针对疗养院居民抑郁、睡眠障碍和躁动的药物管理实践提出了建议。应该进一步研究通过药学护理服务实施的这些算法是否会改善精神药物处方并预防疗养院居民的药物相关问题。
Objectives: In 2002, the canton of Fribourg, Switzerland, implemented a coordinated pharmaceutical care service in nursing homes to promote rational drug use. In the context of this service, a project was conducted to develop recommendations for the pharmacological management of behavioral and psychological symptoms of dementia (BPSD) in nursing home residents.Design and Methods: Selected evidence-based guidelines and meta-analysis sources related to the management of depression, insomnia, and agitation in dementia patients were systematically searched and evaluated. Evidence and controversies regarding the pharmacological treatment of the most common BPSD symptoms were reviewed, and treatment algorithms were developed.Results: Ten evidence-based guidelines and meta-analyses for BPSD management were identified, with none specifically addressing issues related to nursing home residents. Based on this literature, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. For depression, SSRIs are considered the first choice if an antidepressant is required. No clear evidence has been found for sleep disturbances; the underlying conditions need to be investigated closely before the introduction of any drug therapy. Many drugs have been investigated for the treatment of agitation, and if necessary, antipsychotics could be used, although they have significant side effects. Several areas of uncertainty were identified, such as the current controversy about typical and atypical antipsychotic use or the appropriateness of cholinesterase inhibitors for controlling agitation. Treatment algorithms were presented to general practitioners, pharmacists, and medical directors of nursing homes in the canton of Fribourg, and will now be implemented progressively, using educational sessions, pharmaceutical counseling, and monitoring.Conclusion: Based on existing evidence-based studies, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. it should be further studied whether these algorithms implemented through pharmaceutical care services will improve psychotropic drug prescriptions and prevent drug-related problems in nursing home residents.