Zeitgemäßes Management von nicht kognitiven Symptomen bei Demenz

 

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Zusammenfassung

Anlässlich eines Memory-Klinik-Symposiums wurden je acht an Memory-Kliniken in Deutschland, Österreich und der Schweiz tätige Psychiater mithilfe eines standardisierten Fragebogens zu ihren Erfahrungen und Präferenzen in der Therapie nicht kognitiver Symptome bei Demenzpatienten befragt. Die Ergebnisse entsprechen dem in der Literatur dokumentierten Stand der Wissenschaft, wobei den atypischen Antipsychotika und den selektiven Serotoninwiederaufnahmehemmern absoluter Vorrang eingeräumt wird. Niederpotente klassische Antipsychotika und Benzodiazepine werden selektiv eingesetzt und nur für die Bedarfsintervention bevorzugt.

Abstract

Objective: To obtain a cross-sectional overview of therapeutic practice concerning non-cognitive, behavioral signs and symptoms of dementia (BPSD) in Germany, Austria, and Switzerland. Method: We selected 24 psychiatrists (8 from each country) for a questionnaire-based survey with 28 detailed practical questions. Results: Attitudes and preferences were in line with the state of the art as documented in the literature, with the exception of the fact that 30 % of the physicians favored a too brief therapeutic trial with selective serotonin re-uptake inhibitors (SSRIs) for agitation. According to the international literature the preferred treatment of psychotic symptoms in Parkinsons's disease is also a little bit different. Modern atypical antipsychotics, and particularly risperidone, were highly favored for agitation, delirium, psychotic symptoms, and rage outbursts; benzodiazepines (oxazepam and lorazepam), and to an extent also low-potency conventional antipsychotics, were favored only for brief ad hoc medication courses. Anxiety and depressive symptoms were preferentially treated with SSRI, with the exception of short-term therapy of generalized anxiety where benzodiazepines were favored. Benzodiazepines and zolpidem were favored for insomnia without pronounced nocturnal agitation. Conclusion: Psychiatrists at memory clinics in German-speaking Europe have therapeutic attitudes and practices that are consistent with the current state of the art.

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Dr. Michael Rainer

Donauspital am Sozialmedizinischen Zentrum Ost · Psychiatrische Abteilung · Station 38

Langobardenstraße 122

1220 Wien · Österreich

Email: Michael.Rainer@wienkav.at