7BPSD及国际神经病理性疼痛指南进展-2.pptVIP

Which of the following is NOT approved for the treatment of BPSD in dementia patients? ??Memantine ??Rivastigmine ??Galantamine ??Donepezil ??Risperidone Which of the following symptoms or behaviours can be reduced significantly by Memantine in behaviourally disturbed population? ??Agitation ??Aggression ??Irritability ??Delusions ??All Antipsychotic use in dementia patients have been associated with the following: A.Increase in mortality B.Increase in suicide rate C.Increase in cerebrovascular adverse events D.A + B E.A + C BPSD -Definition Behavioral Psychological Symptoms of Dementia (BPSD) : “Symptoms of disturbed perception, thought content, mood, or behavior frequently occurring in patients with dementia” IPA Consensus Conference, 1996 Behavioral:?? Aggression, violence?? Agitation?? Sleep disturbance?? Inappropriate eating behavior?? Dis-inhibition?? Repetitive behavior and verbalization?? Wandering?? Hoarding Psychological Delusion?? Hallucination?? Depression?? Anxiety?? Euphoria?? Labile mood?? Irritability?? Apathy /a-motivation?? Personality change?? Delirium including sun-downing?? Reversal of circadian rhythm Epidemiology of BPSD 1stexamination, 64.3% had ≥1 BPSD symptom ??Only 8.5% remained free of symptoms in 3 years ??75% of dementia patients become depressed ??33% have persecutory ideas ??20% have aggressiveness ??15% have hallucination Devanand, et al. Arch Gen Psychiatry,54(3):257-263,1997 Reisberg, et al. IntPsychogeriatr,8(Suppl 3):301-308,1996 案例 男性/77岁 退休工人 与妻女共同生活 首次到医院门诊(07年10月) 居家，由妻子和保姆照料 PHx: 缺血性心脏病, 深静脉血栓 C/o 认知衰退 2001年以来记忆力差 前列腺癌后电切 短时记忆差 MMSE (5月7号) = 12/30:人格改变, 易激惹定向力障碍\幻觉 私家精神科咨询并开药艾斯能(卡巴拉汀) –依从性差 诊断 VaD可能(中度) + 显著血管性危险因素 BPSD 诊疗计划: 血液检查 脑CT检查 后来证明有多个腔隙性脑梗 再次使用起始剂量1.5mgBD艾斯能（卡巴拉汀）用氟哌啶醇0.5mg BD治疗BPSD 临床进展: 08年2月 卡巴拉汀加量至6mg BD 加用阿司匹林MMSE 重测=14/30 行为症状：尽管使用氟哌啶醇，仍存在下列症状 脱抑制 情感爆发 需要提醒才去洗澡幻觉, 妄想 照料者还有能力照料 临床随访08年10月-12月 有些症状得到改善 但出现更多的BPSD 夜间吵闹 游荡 “玩”大便 骚扰他的妻子(也在OAH) 药物治疗：晚上加1mg的氯羟安定(劳拉西泮