RESUMO
Behavioral and psychological symptoms of dementia pose management challenges for caregivers and clinicians. Firstline nonpharmacologic treatments include eliminating physical and emotional stressors, modifying the patient's environment, and establishing daily routines. Family members and caregivers benefit from education about dementia symptoms and reminders that the behaviors are normal and unintentional. Cognitive and emotion-oriented interventions, sensory stimulation interventions, behavior management techniques, and other psychosocial interventions are modestly effective. In refractory cases, physicians may choose to prescribe off-label antipsychotics. Aripiprazole has the most consistent evidence of symptom improvement; however, this improvement is small. Olanzapine, quetiapine, and risperidone have inconsistent evidence of benefit. Physicians should use the smallest effective dose for the shortest possible duration to minimize adverse effects, most notably an increased mortality risk. Other adverse effects include anticholinergic and antidopaminergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, postural hypotension, metabolic syndrome, cardiac arrhythmia, and sedation. Patients should be monitored for these effects while receiving treatment; however, laboratory monitoring may be limited to patients receiving long-term therapy.
Assuntos
Antipsicóticos/uso terapêutico , Terapia Cognitivo-Comportamental , Demência/terapia , Transtornos Psicóticos/terapia , Aripiprazol/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Doenças dos Gânglios da Base/induzido quimicamente , Terapia Comportamental , Benzodiazepinas/uso terapêutico , Demência/psicologia , Emoções , Humanos , Hipotensão Ortostática/induzido quimicamente , Síndrome Metabólica/induzido quimicamente , Síndrome Maligna Neuroléptica/etiologia , Olanzapina , Guias de Prática Clínica como Assunto , Transtornos Psicóticos/psicologia , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêuticoRESUMO
A retrospective study found more harm than benefit from treating elevated blood pressure in hospitalized noncardiac patients.
Assuntos
Hipertensão , Pacientes Internados , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Estudos RetrospectivosRESUMO
A recent Australian study demonstrated a significant reduction in A-fib recurrence and burden among regular drinkers who abstained from alcohol.