奎硫平
奥氮平
多奈哌齐
利培酮
痴呆
路易氏体型失智症
抗精神病药
路易体
氯氮平
妄想
医学
不利影响
竞争对手
精神科
心理学
疾病
美金刚
血管性痴呆
认知
精神分裂症(面向对象编程)
内科学
作者
Sandra Abou Kassm,Wadih Naja,Nicolas Hoertel,Frédéric Limosin
标识
DOI:10.1684/pnv.2019.0813
摘要
This article aims to review evidence on pharmacologic treatments for the management of delusional symptoms in elderly patients with dementia. Methods We searched PubMed using the words 'delusion', 'dementia' and 'treatment' from January 2007 till November 2017. Results Non-pharmacologic interventions are first-line treatment. Acetyl-cholinesterase inhibitors have shown conflicting results in the treatment of delusions in dementia patients. However, donepezil may be particularly useful in the treatment of psychotic symptoms in Lewy body dementia (LBD). Antipsychotics are reserved for the treatment of severe symptoms. The highest level of evidence exists for risperidone, followed by olanzapine and quetiapine. Clozapine and pimavenserine are therapeutic options for Parkinson disease dementia and LBD. The duration of antipsychotic treatment should not exceed 6 weeks as per the French recommendations (Agence nationale pour la securite du medicament) and 4 months as per the American psychiatric association recommendations. In the event of failure to respond to the aforementioned treatments or as an alternative, antidepressants, in particularly citalopram can be considered. There is not enough evidence to recommend melatonine for the treatment of delusions in dementia patients, although it has been shown to improve behavioral symptoms of dementia in general. Conclusions The choice of medication for the treatment of delusions in dementia patients should be tailored to each patient. The severity of the symptom and its related danger should be considered along with the patient's co-morbidities and the medication's potential adverse effect.
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