Assuntos
Inibidores das Descarboxilases de Aminoácidos Aromáticos/farmacologia , Benserazida/farmacologia , Dopaminérgicos/farmacologia , Epilepsia do Lobo Temporal , Hipercinese , Levodopa/farmacologia , Transtornos dos Movimentos , Diester Fosfórico Hidrolases/genética , Inibidores das Descarboxilases de Aminoácidos Aromáticos/administração & dosagem , Benserazida/administração & dosagem , Criança , Consanguinidade , Dopaminérgicos/administração & dosagem , Combinação de Medicamentos , Epilepsia do Lobo Temporal/tratamento farmacológico , Epilepsia do Lobo Temporal/genética , Feminino , Humanos , Hipercinese/tratamento farmacológico , Hipercinese/genética , Lactente , Levodopa/administração & dosagem , Transtornos dos Movimentos/tratamento farmacológico , Transtornos dos Movimentos/genética , Irmãos , Sequenciamento do ExomaRESUMO
BACKGROUND: Behavioral and psychological symptoms in dementia (BPSD) contribute to caregiver burden and institutionalization of elderly. Neuroleptics are prescribed to control agitation. Side effects of typical neuroleptics are harmful, making atypical neuroleptics an indication. OBJECTIVES: To evaluate efficacy and tolerability of risperidone oral solution (ROS) given once daily to demented elderly outpatients with BPSD (agitation). METHOD: Patients (n=26), 76.35+/-8.63 years, Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) criteria for dementia. RSO was given, starting dose of 0.25 mg and increments of 0.25 mg every week. Mini-Mental State Examination (MMSE) assessed cognitive status, Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) and Clinical Global Impression (CGI) measured BPSD, Extrapiramidal Symptom Rating Scale (ESRS) evaluated extrapyramidal symptoms. Cardiovascular side effects were evaluated clinically. RESULTS: There was a 26% reduction in agitation and no cardiovascular side effects in the range from 1.0 to 1.25 mg. Side effects were more prevalent above 2.5 mg. CONCLUSION: Risperidone oral solution improved agitation with good tolerability from 0.5 to 1.25 mg. A single dose with increments of 0.25 mg may be more acceptable to patients and caregivers.
Assuntos
Antipsicóticos/administração & dosagem , Demência/complicações , Agitação Psicomotora/tratamento farmacológico , Risperidona/administração & dosagem , Administração Oral , Idoso , Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Doenças dos Gânglios da Base/psicologia , Demência/psicologia , Demência Vascular/complicações , Demência Vascular/psicologia , Emoções , Feminino , Humanos , Institucionalização , Masculino , Escalas de Graduação Psiquiátrica , Resultado do TratamentoRESUMO
This study compared the efficacy and tolerability of 150 mg/day imipramine and 50 mg/day sertraline for the treatment of a major depressive episode (DSM-IV) in older adults (N = 55) in an 8-week, randomized, double-blind, controlled clinical trial. Intention-to-treat analysis (last observation carried forwards) showed a reduction of 50% or more on the baseline scores of the Montgomery-Asberg Rating Scale (MADRS) in 60.7% and 55.6% of patients receiving imipramine and sertraline, respectively (p = .698). Full remission of symptoms (MADRS < 9) was observed in 50.0% and 51.8% of patients, respectively (p = .891). Side effects were more frequent among patients treated with imipramine (86.7%) than among patients treated with sertraline (42.1%) (p = .008). Dropout rates were high in both groups (46.4% and 29.6% respectively, p =.200). These results indicate that imipramine and sertraline are equally effective for the treatment of major depression in later life, although adverse reactions are more frequent among subjects treated with imipramine than with sertraline.