A meta-analysis on the efficacy and safety of risperidone in patients with Behavioral and Psychological Symptoms of Dementia (BPSD)

OBJECTIVE: To determine the efficacy and safety of risperidone compared to placebo and haloperidol in the treatment of behavioral and psychological symptoms of dementia. METHODOLOGY: In a systematic review of literature, all articles published from January 1990 - September 2005 that conducted double-blind, randomized controlled clinical trials evaluating the efficacy and safety of risperidone and haloperidol for the treatment of BPSD were selected. The search was performed by means of MEDLINE, PUBMED, Cochrane Library database limited to studies written in English from 1990 to 2005. Key journals and textbooks were also searched in addition to the electronic database search. References mentioned in these studies were likewise reviewed. Two reviewers independently did validity assessment. Analysis of data was done by statistical packs Revman 4.2.7 from Cochrane Collaboration and SPSS (statistical package for the social sciences) v 9.0. RESULTS: Five trials were included in this study. A total of 964 patients were evaluated. Risperidone was superior to placebo as evidenced by significant reduction in the scores of total BEHAVE-AD score (WMD = 2.97, 95% CI = 1.65 - 4.29), BEHAVE-AD aggression subscale (WMD = 1.40, 95% CI = 1.34 - 1.46), and CMAI total aggression subscale (WMD = 3.82, 95% CI = 3.04 - 4.60). Comparison of risperidone and haloperidol showed significant reduction in the total BEHAVE- AD score in patients receiving risperidone (WMD = 1.80, 95% CI = 0.43 - 3.18). Comparing the odds ratio of having an adverse effect, analysis revealed greater chance of developing somnolence (OR = 1.88, 95% CI = 1.27 - 2.77), peripheral edema (OR = 2.43, 95% CI = 1.29 - 4.59) and extrapyramidal symptoms (OR = 1.93, 95% CI = 1.04 - 3.61) with risperidone. CONCLUSION: Risperidone is effective and relatively safe in the treatment of behavioral and psychological symptoms of dementia. Higher incidence of somnolence, peripheral edema and extrapyramidal symptoms was noted with risperidone compared to placebo. Compared with haloperidol, risperidone was superior in the total BEHAVE- AD scale and showed more favorable results in the total CMAI scale, BEHAVE-AD aggression and CMAI total aggression subscales.

Fundamentos teóricos y funciones del psicólogo educativo / Theoretical fundaments and functions of educational psychologist

El artículo tiene como propósito Generar reflexión entre los profesionales y estudiantes de Psicología sobre la necesidad de ampliar la concepción que se tiene del quehacer psicológico en los ámbitos educativos, pues en nuestro medio se observa una concepción restringida, según la cual su actuación se reduce a la aplicación de pruebas psicotécnicas, la realización de escuelas de padres, entre otras actividades que de forma tradiciona desempeña en tales contextos y que están soportadas en aplicaciones de teorías y conceptos de la Psicología conductista. En contraste con esta concepción reduccionista, en el artículo se describen roles y funciones que puede desempeñar el psicólogo en estos contextos y que se nutren de los aportes de las diversas corrientes que existen en Psicología para ampliar el panorama de actuación del psicólogo educativo y su fundamentación epistemológica.

The article aims to create awareness among professionals and students of Psychology on the need to extend conception with psychological work in educational fields because our environment observes a conception restricted, according to which his performance is reduced to the implementation of psycho-technical tests, the realization of parents, among other activities, which are basically supported from the applications of behavioral psychology schools. In contrast to this conception reductionist article discusses a series of roles and functions that can play the psychologist in these contexts, which thrive on the contributions of various currents that exist in psychology, expanding educational psychologist performance landscape.

La formación de profesionales reflexivos y la práctica de Enfermería / The formation of reflective practitioners and nursing practice

En este ensayo se plantea la necesidad de promover en los estudiantes de Enfermería el pensamiento reflexivo ya que como futuros profesionales de la Enfermería requerirán de habilidades de pensamiento crítico, en virtud de que la práctica de Enfermería a la que se enfrentarán implica sistemas de atención a la salud en los que los tipos de toma de decisiones, la complejidad de las necesidades de los pacientes y la cantidad y diversidad de información que utiliza se realiza, siempre, en situaciones de incertidumbre, de inestabilidad, con carácter único y con conflictos de valores. Se resalta la posibilidad de que una enseñanza diferente del proceso de atención de Enfermería bajo esta perspectiva pueda representar por sí misma la aplicación del pensamiento reflexivo. Se concluye planteando algunas estrategias que deberán promover los docentes de Enfermería en los estudiantes para que desarrollen el pensamiento crítico como generador de juicios y toma de decisiones. Las estrategias enfatizan el desarrollo de conocimientos específicos; el aprendizaje experiencial progresivo; las competencias generales y específicas de pensamiento crítico, una enseñanza diferente del proceso de atención de Enfermería que promueva el razonamiento clínico y la inferencia diagnóstica; las habilidades de pensamiento crítico y de disposición al mismo; así como la conformación de estándares intelectuales y profesionales propios de un profesionista universitario.

In this essay, the need to foster the reflexive thinking among nursing students since, as future nursing professionals, they will require critical thinking skills as well as those disposition qualities to it considering the nursing practice is performed in unique situations of uncertainty, instability as well as value conflicts. It's important to point out that the possibility of a different sort of teaching of the nursing process under this perspective can represent the application of the reflexive thinking. It concludes stating some strategies that nursing teachers will have to foster among students for them to develop critical thinking as a judgment creator as well making decision. The strategies point out the development of specific knowledge; the progressive and experiential learning; the general and specific competences of critical thinking; a different approach of teaching the nursing process that foster clinical reasoning and the inferential diagnosis. The skills to set intellectual and professional standards which should be a characteristic of professional nurses.

The Effect of Risperidone on Controlling Behavioral and Psychological Symptoms of Dementia

BACKGROUNDS: Behavioral and psychological symptoms as well as cognitive impairement are very disturbing symptoms in dementia. It is important in managing dementia patient to control these behavioral and psychological symptoms. In this study, we examined the effect of risperidone and optimal therapeutic dosage on controlling these behavioral and psychological symptoms of dementia (BPSD). METHODS: 57 patients (male: 19, female: 38) with dementia, aged 65 and older in Buyeo geriatric hospital located in Buyeo-gun, chung-nam, were finally included in this study. risperidone was administrated to these subjects for 10 weeks to control BPSD. Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) was rated before administration of risperidone and after administration of risperidone for 10 weeks to evaluate the improvement of BPSD. Global Deterioration Scale (GDS) was rated before administration of risperidone. The correlation between baseline GDS score and the change of sum score of BEHAVE-AD was analyzed. RESULT: The mean dose of resperidone at the endpoint was 0.706+/-0.522 mg/d. The significant reduction of the sum score of BEHAVE-AD was observed in subjects after administration of risperidone for 10 weeks. Clinical improvement (> or =50% reduction of sum score of BEHAVE-AD from baseline sum score) was showed in 32 subjects (56.1%) among 57 subjects. Also there was weakly negative correlation between baseline GDS score and the change of sum score of BEHAVE0AD. CONCLUSION: Risperidone was effective in controlling BPSD of dementia patients at 0.706+/-0.522 mg/d.