高齢者の妄想症: 診断と治療の進歩

Esther S Oh^1,2,3, Tamara G Fong^4,5, Tammy T Hshieh⁶

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

JAMA

|October 4, 2017

まとめ

妄想の診断は新しいツールによって改善されています非薬学的予防と治療は効果的ですが,妄想に対する薬物使用は論争の的です.

科学分野:

高齢者医療
クリティカルケア医療
神経科学

背景:

妄想は,注意力や認知の急性障害で,特に高齢者の場合,一般的で深刻で,しばしば致命的です.
患者の機能や生活の質に深刻な影響を及ぼし医療費を大幅に負担します
妄想はしばしば認識されず,診断と管理戦略の改善が必要である.

研究の目的:

妄想症の診断と治療の現状を総合的に説明する.
妄想の理解と管理を進めるために将来の研究のための重要な分野を特定する.
高齢者集団に関連する証拠に焦点を当てる

主な方法:

2011年1月から2017年3月まで,Ovid MEDLINE,Embase,Cochrane Libraryで体系的な文献検索が行われました.
この検索には,高齢者集団に関する研究を中心に,制御された語彙とキーワードが含まれる.
集中治療室や英語以外の言語で書かれた記事は除外された.

主要な成果:

臨床試験,コホート研究,体系的レビューを含む127件の論文が含まれた.
診断の進歩には,3分間の診断評価と4Aテストのような検証されたスクリーニングツールが含まれています.
危険因子 (例えば,不動性,脱水) を標的とした非薬学的介入は,予防と治療に有効である.薬学的治療,特に抗精神病薬は,重度の興奮に留まっています.

結論:

診断手段の改善により妄想の認識とリスクの階層化が促進されます
非薬学的戦略は妄想の予防と治療に有効です.
妄想症の予防と治療における薬理学的介入の役割は,現在も議論の対象であり,さらなる調査が必要である.

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高齢 者 の 妄想 症: 診断 と 治療 の 進歩