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Yıl:2005; Cilt: 1; Sayı: 29>> Özet
Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi Psikiyatri; 2005;1(29):17-25
Demansta Davranış ve Psikolojik Semptomlar
E Eker
Psikiyatri AD, Geropsikiyatri BD, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, İSTANBUL
Demans ilerleyici bilişsel yıkımın günlük yaşam aktivitelerinde azalmanın ve ajitasyon, depresyon ve psikoz gibi davranış ve psikolojik semptomların görüldüğü bir sendromdur. Psikolojik semptomlar özellikle hastalarla ve hasta yakınları ile yapılan görüşmelerle ortaya konur. Bu semptomlar arasında anksiete, depresif duygu durumu, hallusinasyonlar ve hezeyanlar vardır. Davranışsal semptomlar genellikle hastanın gözlenmesi ile saptanır. Fiziksel agresyon, çığlık atma, huzursuzluk, ajitasyon, aşağı-yukarı dolaşma, kültürle uyuşmayan davranışlar, cinsel disinhibisyon, küfür etme, beddua etme davranışsal semptomlar arasındadır.
Son yıllarda davranış ve psikolojik semptomların spesifik tedavilerinde gittikçe artan bir ilgi vardır. Demanstaki hafif davranışsal ve psikolojik semptomlarla başetmede genellikle non-farmokolojik yaklaşımlar birinci sırada yer alır. Ancak semptomlar orta ve ileri derecede ise ilaç tedavi, sıklıkla nonformakolojik yaklaşımlarla birlikte uygulanır. Antipsikotik tedavi hallusinasyonlar, hezeyanlar gibi psikotik semptomların, fiziksel agresyon gibi davranışsal semptomların tedavisinde çok etkilidir. Yeni antipsikotikler, klasik nöroleptikler kadar etkilidirler, ancak daha az yan etkileri vardır.
Behavioral and Psychological Symptoms of Dementia
Dementia is associated with progressive cognitive impairment, the of daily living activities and high prevalence of Behavioral and Psychological Symptoms of Dementia (BPSD) such as ajitation, depression and psychosis. Psychological symptoms are mainly assessed on the basis of interviews with patients and relatives. These symptoms include anxiety, depressive mood, hallucinations and delusions. Behavioral symptoms are usually identified on the basis of observation of the patient, including physical aggression, screaming, restlessness, agitation, wandering, culturally inappropriate behaviors, sexual disinhibition, and cursing.
Recently, there was increased interest in specific therapies for BPSD. Non-pharmacological interventions are usually first-line in dealing with milder behavioral and psychological symptoms of dementia. But for symptoms that are moderate or severe, medication is indicated, often in conjunction with non-pharmacological interventions Antipsychotic medication is most effective in the treatmen of psychotic symptoms such as (hallucinations, delusions) and behavioral symptoms such as physical aggression. Newer antipsychotic medications appear to be at least as effective as conventional neuroleptics, but may have fewer side effects.

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