老年人的妄想:诊断和治疗方面的进展
Esther S Oh1,2,3, Tamara G Fong4,5, Tammy T Hshieh6
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA
|October 4, 2017
概括
妄症的诊断正在通过新工具得到改善. 非药物预防和治疗是有效的,但药物治疗妄仍然存在争议.
科学领域:
- 老年病学
- 危急护理医学
- 神经科学
背景情况:
- 妄想是一种常见的,严重的,经常致命的注意力和认知障碍,特别是在老年人中.
- 它对患者的功能和生活质量产生重大影响,并造成大量的医疗费用.
- Delirium 经常被忽视, 需要改进诊断和管理策略.
研究的目的:
- 提供关于妄症诊断和治疗现状的全面概述.
- 确定未来研究的关键领域,以推进痴呆症的理解和管理.
- 专注于与老年人相关的证据.
主要方法:
- 从2011年1月到2017年3月,在Ovid MEDLINE,Embase和Cochrane图书馆进行了系统的文献搜索.
- 搜索包括受控的词汇和关键词,重点是涉及老年人群的研究.
- 仅基于重症监护室或其他语言的文章被排除在外.
主要成果:
- 包括127篇文章,包括临床试验,队列研究和系统审查.
- 诊断的进步包括验证的查工具,如3分钟诊断评估和4A测试.
- 针对风险因素的非药物干预措施 (例如不运动,脱水) 是有效的预防和治疗;药物治疗,特别是抗精神病药物,只适用于严重的激动.
结论:
- 改进的诊断工具提高了妄想的识别和风险分层.
- 非药物策略是有效的预防和治疗妄症.
- 药物干预预防和治疗妄症的作用仍然是持续辩论的主题,需要进一步研究.
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