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Yıl:2013; Cilt: 3; Sayı: 3>> Özet
Psikiyatride Güncel; 2013;3(3):233-243
Demans hastalarında antipsikotik kullanımı nasıl olmalıdır?
M Çelik, ÖE Aki
Hacettepe Üniversitesi, Ankara
Demansın davranışsal ve psikolojik belirtileri (DDPB) sözel ve fiziksel agresyon, ajitasyon, psikotik belirtiler (varsanılar ve sanrılar), uykuda bozulma ve gezinmeyi içeren bilişsel olmayan belirtileri tarif eder. Bu belirtiler hastalarda ve bakım verenlerde önemli düzeyde zorlanma ve yeti kaybına yol açmaktadır. Demansta davranışsal belirtilerin kontrolü için antipsikotikler başta olmak üzere hemen tüm psikotrop ilaç sınıfları kullanılmıştır. Son yıllarda yapılan çalışmalar antipsikotik ilaçların hem bu belirtileri gidermede minimal bir etkinliğe sahip olduğunu, hem de morbidite ve mortalitede artmaya yol açacak pek çok advers etki oluşturabildiğini göstermiştir. İlk olarak atipik bir antipsikotik olan risperidonla ilgili endişeler sonucu ABD Gıda ve İlaç Dairesi (FDA) tarafından getirilen siyah kutu uyarısı daha sonra tüm atipik ve tipik antipsikotik ilaçları içerecek şekilde genişletilmiştir. Bu uyarıların ardından antipsikotik ilaç kullanımını düzenlemek için kılavuzlar geliştirilmiş ve gereksiz kullanımın önüne geçmek için denetimler yapılmıştır. Ulusal düzeydeki bu çabalar sonucunda İngiltere başta olmak üzere birçok ülkede demanstaki davranışsal belirtiler için antipsikotik kullanımında azalma sağlanmıştır. Ülkemizde sorunun boyutunu belirlemek ve ulusal politika geliştirmek için demans hastalarında antipsikotik ilaç reçetelenmesinin yaygınlığı ve yıllar içindeki değişimini araştıran çalışmalara ihtiyaç duyulmaktadır.
How should antipsychotics be used for dementia patients?
Behavioral and psychological symptoms of dementia (BPSD) describes noncognitive symptoms including verbal and physical aggression, agitation, psychotic symptoms (delusions and hallucinations), sleep impairment, and wandering. These symptoms cause significant distress and disability both in patients and caregivers. Almost all classes of psychotropes have been used to control BPSD. Research in recent years have shown that antipsychotic medications have minimal effectiveness for these symptoms and they can produce many adverse effects including death. US Food and Drug Administration (FDA) issued black box warning first for risperidon and then expanded coverage for all atypical and typical antipsychotics. After these warnings guidelines were developed and audits were performed to prevent unnecessary use of antipsychotics for dementia patients. These efforts caused decrease in rate of antipsychotic prescription for BPSD in many countries, UK being among the leaders. To determine scope of the problem in our country and to develope national policy studies prevalence of antipsychotic prescription for BPSD and trends should be investigated.

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