RESUMO
The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.
Assuntos
Demência/diagnóstico , Demência/tratamento farmacológico , Medicina Baseada em Evidências , Nootrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Aminoácidos/efeitos adversos , Aminoácidos/uso terapêutico , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Inibidores da Colinesterase/efeitos adversos , Inibidores da Colinesterase/uso terapêutico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/tratamento farmacológico , Estudos Transversais , Demência/epidemiologia , Demência/etiologia , Quimioterapia Combinada , Feminino , Ginkgo biloba , Humanos , Incidência , Estilo de Vida , Assistência de Longa Duração , Masculino , Adesão à Medicação , Memantina/efeitos adversos , Memantina/uso terapêutico , Pessoa de Meia-Idade , Extratos Vegetais/efeitos adversos , Extratos Vegetais/uso terapêutico , Dinâmica Populacional , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates. METHODS: Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants. RESULTS: While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers. LIMITATIONS: Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert. CONCLUSIONS: Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates.