Antidepressants for agitation and psychosis in patients with dementia

University of California, San Francisco, USA.
American family physician (Impact Factor: 2.18). 01/2012; 85(1):20-2.
Source: PubMed
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    ABSTRACT: Neurodegenerative diseases are often complicated by psychological and behavioural disturbances. Alzheimer’s disease is not free from such psychiatric complications. Alzheimer’s disease is most frequently the cause of dementia, and the prevalence and incidence of depressive symptoms are high. The prevalence is 40%, half of which are clinically significant and require treatment. When these depressive symptoms occur, they are often associated with other behavioural disturbances such as anxiety, irritability, delusions or apathy. Antidepressants are widely used in Alzheimer’s disease, and they are still prescribed primarily for the management of affective disorders, even though they may be effective in other psychological and behavioural problems. Longitudinal study design and survival analysis are rare. These studies identified functional decline, sleep disturbances and confrontational and aggressive behaviours as the principal predictors of the onset of depressive symptoms in Alzheimer’s disease. These findings confirm that it is important to look for psychiatric symptoms such as depression when non-specific behavioural disturbances such as confrontation or aggressiveness occur. Neuropsychiatric symptoms during the development of neurodegenerative diseases, and of Alzheimer’s disease in particular, offer an exciting area of research. We should consider the biological dimension of depression, which plays a major role in Alzheimer’s disease because of the neurodegenerative process. The neurodegenerative factor alters the clinical expression of depression, its course and response to treatment, whether pharmacological or not.
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    ABSTRACT: Behavioral disturbances are frequently the most challenging manifestations of dementia and are exhibited in almost all people with dementia. Common behavioral disturbances can be grouped into four categories: mood disorders (e.g., depression, apathy, euphoria); sleep disorders (insomnia, hypersomnia, night-day reversal); psychotic symptoms (delusions and hallucinations); and agitation (e.g., pacing, wandering, sexual disinhibition, aggression). They are often persistent, greatly diminish quality of life of patients and their family caregivers, cause premature institutionalization, and pose a high economic burden on the patient, family, and society. Behavioral disturbances can be prevented and treated with a multifaceted approach that supports dignity and promotes comfort and quality of life of persons with dementia and their family members. Management involves prompt treatment of reversible factors and management of symptoms using primarily individualized nonpharmacological interventions. Pharmacological interventions need to be restricted to behavioral emergencies and for short-term treatment of behavioral disturbances that pose imminent danger to self or others.
    Current Psychiatry Reports 05/2012; 14(4):298-309. DOI:10.1007/s11920-012-0288-5 · 3.24 Impact Factor
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