Clinical Trial Studies of Antipsychotics during Symptomatic Presentations of Agitation and/or Psychosis in Alzheimer’s Dementia: A Systematic Review

IF 1.2 Q4 PSYCHIATRY
Haider Qasim, M. Simpson, J. L. Cox
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引用次数: 0

Abstract

Aggressive behaviors of people with dementia pose a significant challenge to employees in nursing homes and aged care facilities. Aggressive behavior is a result of psychomotor agitation in dementia (BPSD). Globally, psychotropic interventions are the preferred treatment for BPSD. However, it is still unclear which psychotropic should be prescribed. The purpose of this systematic review is to compare pharmacological interventions for psychomotor agitation and psychosis symptoms. Method: The studies were extracted from databases, such as PubMed, OVID, and Cochrane, with a date restriction from 2000 to present, and in English. PRISMA steps were used to refine the extracted data. The RCTs extracted for this systematic review compared active ingredient medications to one another or to a placebo. Results: PRISMA was used to assess all selected trials comprehensively. Four trials are being conducted on quetiapine, two on haloperidol, one on olanzapine, three on risperidone, one on brexpiprazole, one on pimavanserin, and two on aripiprazole. Compared to typical antipsychotics, quetiapine showed tolerable adverse effects and did not worsen parkinsonism. Psychosis symptoms and behavioral improvements can be improved with haloperidol. Among elderly patients with psychosis, risperidone reduces angriness, paranoia, and aggression, as well as improves global functioning. As compared with other antipsychotics, aripiprazole provides a lower risk of adverse effects and demonstrated improvement in agitation, anxiety, and depression associated with psychosis. While olanzapine improves hostile suspiciousness, hallucinations, aggression, mistrust, and uncooperativeness, it worsens depression symptoms. Psychosis was treated effectively with pimavanserin without adverse effects on motor functions. Psychosis symptoms are well tolerated by brexpiprazole, but insomnia, headache, and urinary tract infections are common side effects. Conclusions: In this systematic review, we provide an overview of how to choose the correct antipsychotics and dosages for the management of BPSD and emphasize the importance of safe and conservative use of these drugs.
抗精神病药物在阿尔茨海默氏痴呆患者躁动和/或精神病症状表现中的临床试验研究:系统综述
痴呆症患者的攻击行为对养老院和老年护理机构的工作人员构成了重大挑战。攻击行为是痴呆(BPSD)中精神运动性躁动的结果。在全球范围内,精神药物干预是BPSD的首选治疗方法。然而,目前还不清楚应该开哪种精神药物。本系统综述的目的是比较精神运动性躁动和精神病症状的药物干预。方法:研究从PubMed、OVID和Cochrane等数据库中提取,日期限制为2000年至今,且为英文。采用PRISMA步骤对提取的数据进行细化。本系统综述提取的随机对照试验将活性成分药物相互比较或与安慰剂比较。结果:采用PRISMA对所选试验进行综合评价。正在对喹硫平进行四项试验,氟哌啶醇进行两项试验,奥氮平进行一项试验,利培酮进行三项试验,brexpiprazole进行一项试验,pimavanserin进行一项试验,阿立哌唑进行两项试验。与典型的抗精神病药物相比,喹硫平表现出可容忍的不良反应,并没有加重帕金森病。氟哌啶醇可改善精神病症状和行为改善。在老年精神病患者中,利培酮可减少愤怒、偏执和攻击性,并改善整体功能。与其他抗精神病药物相比,阿立哌唑的不良反应风险较低,并可改善与精神病相关的躁动、焦虑和抑郁。虽然奥氮平可以改善敌意猜疑、幻觉、攻击性、不信任和不合作,但它会加重抑郁症状。匹马万色林治疗精神病有效,对运动功能无不良影响。brexpiprazole能很好地耐受精神病症状,但失眠、头痛和尿路感染是常见的副作用。结论:在本系统综述中,我们概述了如何选择正确的抗精神病药物和剂量来治疗BPSD,并强调了安全、保守使用这些药物的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.90
自引率
0.00%
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0
审稿时长
11 weeks
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