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Pharmacologische behandeling delirium

1. Acuut begin en wisselend verloop
 a) acute veranderingen gaande van enkele uren tot dagen tov  b) gedragsveranderingen in de loop van de dag 2. Onoplettendheid/aandachtsstoornis
 Concentratiemoeilijkheden/gemakkelijk afgeleid/moeilijk volgen 3. Verward denken
 Onsamenhangend-onlogisch-onvoorspelbare gedachtengang 4. Veranderde mate van bewustzijn
 + direct gevolg van een organische oorzaak Delirium zo 1(a) + 1(b) en 2 en (3 of 4) positief gescoord worden • farmacologisch behandelen indien symptomen – gevaar voor onderbreken (levens)-noodzakelijke • beademing, centrale katheters, maagsonde – delirium/therapy (Mesh): 1576 artikels Treatment of agitation in AD outpatients a radomized, placebo-controled clinical trial (16 weeks) Behavior
haloperidol trazodone placebo overall
management
NPI score (agitation/agression, hallucinations, delusions) in NH residents with AD and psychotic/behavioral symptoms Olanzapine 5 mg/d, 10 mg/d, 15 mg/d, placebo Effectiveness of atypical antipsychotic drugs in • RCT met 421 ambulant en thuiswonende AD patiënten met psychose, agressie of agitatie • Vergelijking ZYP (▲ 5.5 mg/d), RIS (▲ 1 mg/d), • SER en PLAC vroeger gestopt wegens gebrek • ZYP, RIS, SER frekwenter gestopt dan PLAC Zijn atypische neuroleptica veiliger dan Nevenwerkingen (in %) CATIE-AD Study Group Nevenwerkingen (in %) CATIE-AD Study Group cholesterol ∆ tot laatste -11.3 mg -1.9 mg 11 october 2002, http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/medeff/risperdal_hpc-cps-eng.pdf Antipsychotic drugs an sudden cardiac death Low dose: haloperidol < 2 mg, olanzapine < 5 mg, quetiapine < 75 mg, risperidone < 2 mg Antipsychotic therapy and short-term (< 30d) serious Low dose: haloperidol < 2 mg, olanzapine < 5 mg, quetiapine < 75 mg, risperidone < 2 mg A double-blind comparison of citalopram and risperidone for the treatment
of behavioral and psychotic symptoms associated with dementia
Neurobehavioral rating scale (1 not present => 7 extremely severe)
8: DISINHIBITION: socially inappropriate comments and/or actions, including aggressive/sexual content, outbursts of
temper,…)
11: AGITATION: motor manifestations of overactivation ( eg kicking, arm flailing, picking, roaming, …)
14: HOSTILITY/UNCOOPERATIVENESS: animosity, irritability, disdain for others, belligrence,…)

Am J Geriatr Psychiatry 2007; 15:942-952 Antidepressants for agitation and psychosis in There is some evidence to support the use of certain antidepressants for agitation and psychosis in dementia and further studies are required to determine the effectiveness and safety of SSRIs and trazodone in managing these symptoms • Atypische AP1 vs atypische AP2 vs atypische AP3 ? • Evidentie dat antidepressiva > placebo • Typische AP > = < atypische AP ? Eerst somatische oorzaak diagnosticeren en behandelen bijsluiter België delirium
Eerste keuze in richtlijnen door expert opinie, niet door kwaliteit RCT’s

Source: http://cdn.nimbu.io/s/1kphvhi/assets/Medisch_symposium_-_10_-_Etienne_Joosten_-_11.35_-_.pdf

Ken470 520.527

Advance Access publication 24 December 2008Analgesic effects of treatments for non-specific low back pain:a meta-analysis of placebo-controlled randomized trialsL. A. C. Machado1, S. J. Kamper1, R. D. Herbert1, C. G. Maher1 and J. H. McAuley2Objective. Estimates of treatment effects reported in placebo-controlled randomized trials are less subject to bias than those estimatesprovided by other s

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Correlation of Subepithelial Haze and Refractive Regression 1 Month After Photorefractive Keratectomy for Myopia Dimitrios S. Siganos, MD; Vikentia J. Katsanevaki, MD; Ioannis G. Pallikaris, MD after PRK for myopia is strongly related to regres- ABSTRACT sion of initial refractive effect and increasing PURPOSE: To relate myopic regression after myopia. [ J Refract Surg 1999;15:3

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