向精神薬の実際的な使用法―精神科での経験から―

抄録

Behavioral and psychological symptoms of dementia (BPSD) including agitation, delusion, depression and anxiety have been assumed to impose greater burden on family caregivers than cognitive dysfunction. Treatment of these symptoms often requires urgent interventions involving pharmacotherapy. Psychotropic drugs, antipsychotics in particular, could, however, produce both beneficial and harmful effects on aged patients. Thus there develops a wider trend towards treating BPSD of mild to moderate severity preferentially with a various types of emerging psychosocial methods, which are assumed to be generally effective. Pharmacotherapy using antipsychotics should thus be justified only for the patients with severe BPSD or unsatisfactory response to psychosocial treatment. Although atypical antipsychotics are often chosen for treating BPSD of any degree of severity, cholinesterase inhibitor, tiapride or valproate are first recommended for minimizing adverse events such as dysphagia and fall, if the severity of BPSD is mild to moderate. When the use of antipsychotics is needed, we should attempt to limit their use in dosage and duration with greatest caution with the understanding that short–term, low–dose treatment is sufficient for most patients. Through careful selection of appropriate patients for treatment, education of caregivers, and close monitoring, safety risks can be minimized.