Advances in the treatment of psychiatric disorders in long-term care homes

作者：Conn David K^*; Seitz Dallas P

来源：Current Opinion in Psychiatry, 2010, 23(6): 516-521.

DOI：10.1097/YCO.0b013e32833efe56

• dementia
• depression
• long-term care
• mental health
• nursing home
• psychiatric disorders
• psychosocial interventions

Purpose of review
Psychiatric disorders are common among older adults in long-term care (LTC) homes and the LTC population is rapidly growing in many countries. Treatment of psychiatric conditions in this population is challenging given the psychosocial environment and physical frailty of the population. This review highlights some important advances in pharmacological and nonpharmacological interventions in this setting.
Recent findings
There is some evidence to support the use of psychosocial interventions for behavioral symptoms, including those utilizing sensory interventions such as aromatherapy and calming music; behavioral management techniques; cognitive stimulation; physical activity; and staff training. There is also some evidence to support the use of psychotherapies such as reminiscence therapy and cognitive behavior therapy for depression. Recent literature on the pharmacological management of behavioral symptoms of dementia have included studies of the antipsychotic aripiprazole, prazosin, and medication-discontinuation trials along with two negative studies involving melatonin and oxcarbazepine.
Summary
The literature on psychosocial interventions for behavioral symptoms associated with dementia has been criticized for lack of vigor, but there is growing evidence from studies with improved methodology that these interventions may confer significant benefits, although the effect sizes are often small or moderate. More well designed trials of pharmacological therapies in the LTC population are also necessary.

• 出版日期2010-11