Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care
Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care
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DOI：
10.1080/13607863.2016.1277974
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发表时间：
2018-01-01
影响因子：
3.4
通讯作者：
Briesacher, Becky
中科院分区：
文献类型：
--
作者：
Olivieri-Mui, Brianne L.;Devlin, John W.;Briesacher, Becky
目的：为了比较临床医生的看法，抗精神病药的治疗替代品，为老年痴呆症患者在长期护理（LTC）和发表的证据之间的差异：混合方法的方法，包括药物信息搜索，在线调查55 LTC临床医生和全面的文献综述。对于确定的41种药物抗精神病药物替代品候选者，LTC临床医生评估了他们替代痴呆患者的可能性，并确定了非药物抗精神病药物替代品。质量的证据支持最有可能的抗精神病药物的替代品进行了评估，使用修改后的GRADE approach.Results：在36（65%）的LTC临床医生回应，药理学候选人被认为可能或有点可能被取代的抗精神病药物是：丙戊酸、5-羟色胺调节剂抗抑郁药、短效苯二氮卓类、5-羟色胺再摄取抑制剂抗抑郁药、α-肾上腺素受体拮抗剂、丁螺环酮，对乙酰氨基酚、去甲肾上腺素再摄取抑制剂抗抑郁药、美金刚和胆碱酯酶抑制剂。仅美金刚和胆碱酯酶抑制剂存在支持这些替代的高质量证据，而丙戊酸存在警告这种替代的高质量证据。活动和音乐疗法是最常引用的非药物替代品，但支持的证据是sparse.Conclusion：LTC临床医生对LTC痴呆患者的抗精神病药物替代品的看法差异很大，往往与已发表的证据不一致。
Objective: To compare differences between clinician perceptions of therapeutic substitutes for antipsychotics prescribed to patients with dementia in long term care (LTC) and published evidence.Methods: A mixed-methods approach that included a drug information search, online survey of 55 LTC clinicians and a comprehensive literature review was used. For 41 pharmacologic antipsychotic substitute candidates identified, LTC clinicians rated the likelihood they would substitute each for patients with dementia and identified non-pharmacologic antipsychotic substitutes. The quality of evidence supporting the most likely antipsychotic substitutes was assessed using a modified GRADE approach.Results: Among 36 (65%) of LTC clinicians responding, the pharmacologic candidates deemed likely or somewhat likely to be substituted for an antipsychotic were: valproic acid, serotonin modulator antidepressants, short-acting benzodiazepines, serotonin reuptake inhibitor antidepressants, alpha-adrenoceptor antagonist, buspirone, acetaminophen, serotonin-norepinephrine reuptake inhibitor antidepressants, memantine, and a cholinesterase inhibitor. High quality evidence supporting these substitutions existed for only memantine and cholinesterase inhibitors, while high quality evidence cautioning against this substitution existed for valproic acid. Activities and music therapy were the most commonly cited non-pharmacologic substitutes but the supporting evidence for each is sparse.Conclusion: Perceptions of LTC clinicians regarding substitutes for antipsychotics in LTC patients with dementia vary widely and are often discordant with published evidence.