DITORIALTOOLSFORPRACTICEAntipsychoticsforagitationindementiaJoeyTonPharmDJamilRamjiACPRG.
MichaelAllanMDCCFPClinicalquestionWhatarethebeneftsandharmsofantipsychoticsforagitationindementiaBottomlineAntipsychoticsprovidelittleimprovementoverpla-ceboonagitationscales.
However,a50%improve-mentinbehaviouroccursinabout46%ofthosetakingantipsychoticsversusabout33%takingpla-cebo.
Harmsareserious(eg,1increaseddeathin80over3months)andcommon.
Antipsychoticsshouldbereservedforsevereaggression,andwithdrawalshouldbeattemptedassoonaspossible.
EvidenceEvidenceincludes6systematicreviews(5to16RCTsof856to5110patientsthatlasted10to12weeks).
1-6Resultsarestatisticallysignifcantunlessindicatedotherwise.
Placebohadlargeeffects(eg,11-pointincreaseona144-pointscale—aclinicallymeaningfuldifference).
7Studiesofatypicalantipsychoticsrevealedthefollowing:-Meanimprovementonmultiplescaleswastrivial(eg,3ona144-pointscale[notlikelyclinicallymeaningful]).
1-3-Individualantipsychoticshadgenerallysimilarresults.
2,5-Somepatientsattained50%improvementonscales(eg,46%withrisperidonevs33%withplacebo,num-berneededtotreat[NNT]=8).
4-Harmsincludedstoppingowingtoadverseevents(numberneededtoharm[NNH]=13to39).
2Seriousharmsincludeddeath(NNH=77to84)1,4andcerebro-vascularevents(NNH=48to104).
1,2,4-Mini-MentalStateExaminationscorewas0.
73pointsworse(statistically,notclinically,signifcant).
4-Otherharmsweresomnolence(NNH=7to11),gaitabnormalities(NNH=11to20),extrapyramidalsymptoms(NNH=16to44),andperipheraledema(NNH=20to25).
1,2,4First-generationantipsychotics(eg,haloperidol)appeartohavesimilarratesofharmsbutinconsis-tentbenefts.
6ContextCholinesteraseinhibitors,selectiveserotoninreuptakeinhibitors,trazodone,andvalproateprovidenomean-ingfulimprovementinagitation.
8-11-Benzodiazepinesmightapproachantipsychoticsineffcacyforagitationbutalsohaveharms.
12Stoppingantipsychoticsmightreducedeath(NNT=4at2years)withlittleeffectonneuropsychiatricsymptoms.
13ImplementationMedical,psychological,andenvironmentaltriggersshouldbeassessedandtargetedinpatientswithagita-tion.
14Painisacommoncauseofagitationindementia,occurringin57%ofpatients,andpainresolutioncanimproveagitation.
15A3Rsapproach(repeat,reassure,redirect)isrecommended.
14Insevereaggressionthatthreatensthesafetyofthepatientorothers,useatypicalantipsychoticstotargetsymptomswithoutsedatingthepatient.
16Thelowesteffectivedoseshouldbeusedfortheshortesttime.
Adeprescribingalgorithmisavailable.
16DrTonandMrRamjiareKnowledgeTranslationExpertswiththePEERGroupintheDepartmentofFamilyMedicineandinthePhysicianLearningProgramattheUniversityofAlbertainEdmonton.
DrAllanisProfessorwiththePEERGroupintheDepartmentofFamilyMedicineattheUniversityofAlberta.
CompetinginterestsNonedeclaredTheopinionsexpressedinToolsforPracticearticlesarethoseoftheauthorsanddonotnecessarilymirrortheperspectiveandpolicyoftheAlbertaCollegeofFamilyPhysicians.
References1.
MaH,HuangY,CongZ,WangY,JiangW,GaoS,etal.
Theeffcacyandsafetyofatypicalantipsy-choticsforthetreatmentofdementia:ameta-analysisofrandomizedplacebo-controlledtrials.
JAlzheimersDis2014;42(3):915-37.
2.
BallardCG,WaiteJ,BirksJ.
AtypicalantipsychoticsforaggressionandpsychosisinAlzheimer'sdisease.
CochraneDatabaseSystRev2006;(1):CD003476.
3.
YuryCA,FisherJE.
Meta-analysisoftheeffectivenessofatypicalantipsychoticsforthetreatmentofbehaviouralproblemsinpersonswithdementia.
PsychotherPsychosom2007;76(4):213-8.
4.
SchneiderLS,DagermanK,InselPS.
Effcacyandadverseeffectsofatypicalantipsychoticsfordemen-tia:meta-analysisofrandomized,placebo-controlledtrials.
AmJGeriatrPsychiatry2006;14(3):191-210.
5.
CheungG,StapelbergJ.
Quetiapineforthetreatmentofbehaviouralandpsychologicalsymp-tomsofdementia(BPSD):ameta-analysisofrandomisedplacebo-controlledtrials.
NZMedJ2011;124(1336):39-50.
6.
LonerganE,LuxenbergJ,ColfordJM,BirksJ.
Haloperidolforagitationindementia.
CochraneDatabaseSystRev2002;(2):CD002852.
7.
RosenbergPB,DryeLT,PorsteinssonAP,PollockBG,DevanandDP,FrangakisC,etal.
ChangeinagitationinAlzheimer'sdiseaseintheplaceboarmofanine-weekcontrolledtrial.
IntPsycho-geriatr2015;27(12):2059-67.
8.
CampbellN,AyubA,MalazBoustaniM,FoxC,FarlowMR,MaidmentI,etal.
Impactofcholines-teraseinhibitorsonbehavioralandpsychologicalsymptomsofAlzheimer'sdisease:ameta-analysis.
ClinIntervAging2008;3(4):719-28.
9.
SeitzDP,AdunuriN,GillSS,GruneirA,HerrmannN,RochonP.
Antidepressantsforagitationandpsychosisindementia.
CochraneDatabaseSystRev2011;(2):CD008191.
10.
Martinn-TorresG,FioravantiM,GrimleyEvansJ.
Trazodoneforagitationindementia.
CochraneDatabaseSystRev2004;(3):CD004990.
11.
LonerganE,LuxenbergJ.
Valproatepreparationsforagitationindementia.
CochraneDatabaseSystRev2009;(3):CD003945.
12.
McCrackenR,AllanGM.
Agitationindementia–arebenzosabackupEdmonton,AB:ToolsforPractice;2015.
13.
AllanGM,BehnSmithD.
WhataretherisksofstoppingantipsychoticsintheelderlyEdmonton,AB:ToolsforPractice;2013.
14.
SadowskyCH,GalvinJE.
Guidelinesforthemanagementofcognitiveandbehavioralproblemsindementia.
JAmBoardFamMed2012;25(3):350-66.
15.
HuseboBS,BallardC,SandvikR,NilsenOB,AarslandD.
Effcacyoftreatingpaintoreducebehaviouraldisturbancesinresidentsofnursinghomeswithdementia:clusterrandomisedclinicaltrial.
BMJ2011;343:d4065.
16.
BjerreLM,FarrellB,HogelM,GrahamL,LemayG,McCarthyL,etal.
Deprescribingantipsychoticsforbehaviouralandpsychologicalsymptomsofdementiaandinsomnia.
Evidence-basedclini-calpracticeguideline.
CanFamPhysician2018;64:17-27(Eng),e1-12(Fr).
ThisarticleiseligibleforMainpro+certifedSelf-Learningcredits.
Toearncredits,gotowww.
cfp.
caandclickontheMainpro+link.
Latraductionenfranaisdecetarticlesetrouveàwww.
cfp.
cadanslatabledesmatièresdunumérodemai2018àlapagee232.
ToolsforPracticearticlesinCanadianFamilyPhysicianareadaptedfromarticlespublishedontheAlbertaCollegeofFamilyPhysicians(ACFP)website,summarizingmedicalevidencewithafocusontopicalissuesandpractice-modifyinginformation.
TheACFPsummariesandtheseriesinCanadianFamilyPhysicianarecoordinatedbyDrG.
MichaelAllan,andthesummariesareco-authoredbyatleast1practisingfamilyphysicianandarepeerreviewed.
Feedbackiswelcomeandcanbesenttotoolsforpractice@cfpc.
ca.
ArchivedarticlesareavailableontheACFPwebsite:www.
acfp.
ca.
Vol64:MAY|MAI2018|CanadianFamilyPhysician|LeMédecindefamillecanadien369
OneTechCloud(易科云)是一家主打CN2等高端线路的VPS主机商家,成立于2019年,提供的产品包括VPS主机和独立服务器租用等,数据中心可选美国洛杉矶、中国香港、日本等,有CN2 GIA线路、AS9929、高防、原生IP等。目前商家针对全场VPS主机提供月付9折,季付8折优惠码,优惠后香港VPS最低季付64元起(≈21.3元/月),美国洛杉矶CN2 GIA线路+20Gbps防御型VPS...
hostsailor怎么样?hostsailor成立多年,是一家罗马尼亚主机商家,机房就设在罗马尼亚,具说商家对内容管理的还是比较宽松的,商家提供虚拟主机、VPS及独立服务器,今天收到商家推送的八月优惠,针对所有的产品都有相应的优惠,商家的VPS产品分为KVM和OpenVZ两种架构,OVZ的比较便宜,有这方面需要的朋友可以看看。点击进入:hostsailor商家官方网站HostSailor优惠活动...
HostKvm也发布了开年促销方案,针对香港国际和美国洛杉矶两个机房的VPS主机提供7折优惠码,其他机房业务提供8折优惠码。商家成立于2013年,提供基于KVM架构的VPS主机,可选数据中心包括日本、新加坡、韩国、美国、中国香港等多个地区机房,均为国内直连或优化线路,延迟较低,适合建站或者远程办公等。下面列出几款主机配置信息。美国洛杉矶套餐:美国 US-Plan1CPU:1core内存:2GB硬盘...
nnt为你推荐
虚拟空间租赁虚拟主机租用价格多少钱一年服务器空间租用我自己搞了个服务器,怎么租空间给别人啊?域名服务商比较专业的域名服务商有哪些?好的域名和域名服务商没关系吧?com域名注册com域名注册要注意哪些情况啊?我想现在注册一个com域名~国内ip代理全国各省代理IP网站域名空间网站域名和空间域名备案域名需要备案吗?成都虚拟空间五星网络隶属于成都冠一科技有限公司,虚拟空间购买了不到一个月不能访问2次,质量真差啊!jsp虚拟空间jsp虚拟主机有支持的吗重庆网站空间重庆有没有发展空间?
虚拟主机99idc 老域名失效请用户记下 域名转让 提供香港vps 域名商 荷兰服务器 踢楼 edis googleapps 搬瓦工官网 免费网站监控 parseerror 免费博客空间 主机合租 e蜗牛 域名转接 赞助 tna官网 hkt 东莞idc 更多