The use of novel antipsychotics in the older patient with neurodegenerative disorders in the long-term care setting.
The use of novel antipsychotics in the older patient with neurodegenerative disorders in the long-term care setting.
复制标题
在长期护理环境中对患有神经退行性疾病的老年患者使用新型抗精神病药物。
DOI：
10.1097/01.jam.0000129822.54487.14
复制
发表时间：
2004
影响因子：
7.6
通讯作者：
Mohamed,S
中科院分区：
文献类型：
--
作者：
Kasckow,JW;Mulchahey,JJ;Mohamed,S
治疗患有神经退行性疾病的老年患者面临许多挑战。预计未来几年老年患者人数将显着增加；因此，需要治疗的人数将会不断增加。因此，适当选择精神药理学药物成为使用非典型抗精神病药物治疗老年患者的重要决定。由于副作用风险较低，非典型抗精神病药物正在取代长期护理机构中的高效传统抗精神病药物。例如，非典型抗精神病药的锥体外系副作用和迟发性运动障碍的发生率较低。已经发表了检查利培酮和奥氮平使用的双盲安慰剂对照试验，表明这两种药物可以安全有效地减轻患有神经退行性疾病的长期护理患者的躁动症状。例如，根据这些研究，治疗痴呆症行为激越有效的剂量是每天 0.5 至 1.5 毫克利培酮和每天 5 至 10 毫克奥氮平。此外，还有一些开放标签研究检查了喹硫平的使用，表明该药物对痴呆症患者也是安全有效的。使用剂量范围约为每天 25 至 350 毫克。很少有研究检查最新的非典型抗精神病药物齐拉西酮和阿立哌唑对神经退行性疾病患者的作用。这些研究确实表明齐拉西酮和阿立哌唑在长期护理环境中值得进一步研究。
Treating older patients with neurodegenerative disorders involves numerous challenges. The older patient population is expected to increase appreciably in the coming years; thus, there will be increasing numbers of these individuals requiring treatment. As a result, the appropriate choice of psychopharmacologic agents becomes an important decision in treating older patients with atypical antipsychotics. The atypical antipsychotic medications are replacing the high-potency conventional antipsychotics in the long-term care setting because of the lower risks of side effects. For instance, atypical antipsychotics have lower rates of extrapyramidal side effects and tardive dyskinesia. Double-blind placebo-controlled trials examining the use of risperidone and olanzapine have been published and indicate that both agents safely and effectively reduce agitation symptoms in long-term care patients with neurodegenerative disorders. For instance, based on these studies, the doses that appear efficacious in treating behavioral agitation in dementia are 0.5 to 1.5 mg per day of risperidone and 5 to 10 mg per day of olanzapine. In addition, there are open-label studies examining the use of quetiapine, which suggest that this agent is also safe and efficacious in patients with dementia. Doses used range approximately from 25 to 350 mg per day. Very few studies are available examining the newest atypical antipsychotics, ziprasidone and aripiprazole, in patients with neurodegenerative disorders. These studies do suggest that ziprasidone and aripiprazole are worth further study in the long-term care setting.