psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2020-18-4-6-15psychiatry-543Research ArticleПСИХОПАТОЛОГИЯ, КЛИНИЧЕСКАЯ И БИОЛОГИЧЕСКАЯ ПСИХИАТРИЯPSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRYНейропсихиатрические симптомы и антипсихотическая терапия у пожилых пациентов с деменциейNeuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementiahttps://orcid.org/0000-0002-2358-1579КолыхаловИ. В.KolykhalovI. V.

Колыхалов Игорь Владимирович, доктор медицинских наук, отдел гериатрической психиатрии

Москва

Igor V. Kolykhalov, MD, PhD, Dr. of Sci. (Med.), Geriatric Psychiatry Department

Moscow

ikolykhalov@yandex.ruФГБНУ «Научный центр психического здоровья»РоссияFSBSI “Mental Health Research Centre”Russian Federation202014122020184615Copyright © Колыхалов И.В., 20202020Колыхалов И.В.Kolykhalov I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/543Цель исследования

Цель исследования: изучить синдромально-нозологические особенности нейропсихиатрических симптомов (НПС) и частоту применения антипсихотиков у пациентов с различными типами деменции, госпитализированных в гериатрические отделения психиатрической больницы.

Пациенты и методы

Пациенты и методы: обследовано 106 больных, находившихся на стационарном лечении в трех психогериатрических отделениях. Медиана возраста больных - 75 лет [69; 80]. Диагностическое распределение больных на момент проведения обследования было следующим: у 33 больных (31,1%) диагностирована болезнь Альцгеймера (БА), у 25 (23,6%) - смешанная деменция (СмД), у 32 (30,2%) — сосудистая деменция (СД) и у 16 (15,1%) пациентов - деменция сложного генеза (ДСГ).

Результаты

Результаты: установлена высокая частота (54,7%) НПС у пациентов с деменцией различного генеза, поступающих на лечение в геронтопсихиатрические отделения психиатрического стационара. Наибольшее число больных с поведенческими и психотическими симптомами выявлено при БА и СмД. Доля больных с такими расстройствами при каждом из этих типов деменции составляет около 70%, тогда как при ДСГ и СД доля пациентов с НПС заметно меньше (соответственно 30 и 40%). Для лечения НПС наиболее часто назначались нейролептики, однако их использование вызывало нежелательные явления (НЯ) в 1/3 случаев. Наиболее подвержены развитию НЯ больные СД, наименее - больные БА.

Заключение

Заключение: проведенное исследование показало, что НПС являются одними из важных компонентов деменции, независимо от нозологии и стадии заболевания. Лечение НПС при деменции является особенно сложной задачей, так как хотя симптомы и вызывают значительные расстройства, но на текущий момент отсутствуют эффективные альтернативные методы терапии. Риск НЯ может быть сведен к минимуму путем тщательного учета показаний к назначению антипсихотиков и их непродолжительному применению, регулярным мониторингом состояния больного, просвещением ухаживающих лиц.

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.

Patients and methods

Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).

Results

Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.

Conclusion

Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

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The authors declare that there are no conflicts of interest present.