CONTINUATION PHARMACOTHERAPY FOR AGITATION OF DEMENTIA

痴呆症躁动的持续药物治疗

• 批准号: 6700220
• 负责人: BRUCE G POLLOCK
• 金额: $ 29.97万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-03-15 至 2006-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6700220
• 关键词: Alzheimer' s disease; antidepressants; antipsychotic agents; anxiety; behavior test; behavioral /social science research tag; clearance rate; clinical research; dementia; drug adverse effect; functional ability; gene frequency; hospital length of stay; human subject; human therapy evaluation; isozymes; mental disorder chemotherapy; mental health facility; outcomes research; relapse /recurrence; risperidone; serotonin inhibitor; serotonin receptor; serotonin transporter; therapy compliance

DESCRIPTION (Adapted from the Applicant's Abstract): The primary goal of this revised application (MH59666) "Continuation Pharmacotherapy for Agitation of Dementia" is to conduct a 12-week, double-blind study of the comparative effectiveness of the highly selective, serotonin reuptake inhibitor, citalopram, and the atypical antipsychotic, dsperidone in 103 patients suffering from behavioral disturbances associated with Alzheimer's dementia (BDAD). This study focuses on patients with Alzheimer's disease and its Lewy body variant who are most severely affected: those who have required initial hospitalization for BDAD. Symptomatic management of BDAD in the hospital has greatly improved over the past five years. Unfortunately, shortened lengths of stay are now mandated and BDAD has a high likelihood to recur and repeated hospitalizations are associated with more rapid functional decline. Our pilot data suggest that the antidepressant citalopram is acutely beneficial for both psychotic and non-psychotic BDAD symptoms in hospitalized patients, at least in the short-term. Attenuation of agitation and psychotic symptoms achieved with citalopram appeared to be equivalent to, or better than that achieved with our prior treatment standard, the conventional neuroleptic, perphenazine. The increase in side effect burden for the perphenazine-treated patients was significant, however, in contrast to the citalopram and placebo groups. Nonetheless, this efficacy study was conducted in a highly controlled, specialized, inpatient environment, for a very brief period of time (17 days). Moreover, in community-practice, the atypical antipsychotic, rispeddone has become a first-line medication for BDAD. To address continuing treatment in the community or in the nursing home (i.e., outside of our academic setting) we have established a system of treatment and assessment for BDAD patients upon their discharge from the hospital. Medication assignment and dosage adjustments will remain blinded and patients will be carefully monitored. In addition to clinical and behavioral assessments of outcomes, the proposed study will also examine whether therapeutic response is associated with inter-individual allelic variations in the serotonin transporter promoter, serotonin 2N2C receptors, and CYP2D6 drug metabolizing isoenzyme. Drug plasma level monitoring will be utilized to assess the impact of variance in drug exposure due to deviations in compliance or drug clearance.

描述（改编自申请人的摘要）：本报告的主要目标 修订申请（MH59666）“持续药物治疗激越 痴呆症”将进行一项为期 12 周的双盲比较研究 高选择性血清素再摄取抑制剂的有效性， 西酞普兰和非典型抗精神病药物二哌酮治疗 103 名患者 患有与阿尔茨海默氏痴呆症相关的行为障碍 （BDAD）。这项研究的重点是阿尔茨海默氏病及其路易氏病患者 受影响最严重的身体变异：那些需要初始治疗的人 因 BDAD 住院。医院对 BDAD 进行症状管理 五年来有了很大的进步。不幸的是，长度缩短了 现在强制执行居留，BDAD 复发和重复的可能性很高 住院治疗与更快的功能衰退有关。我们的飞行员 数据表明，抗抑郁药西酞普兰对两者都非常有益 住院患者的精神病性和非精神病性 BDAD 症状，至少在 短期的。减轻躁动和精神病症状 西酞普兰似乎相当于或优于我们的 既往治疗标准，常规精神安定药、奋乃静。这 奋乃静治疗患者的副作用负担增加 然而，与西酞普兰组和安慰剂组相比，差异显着。 尽管如此，这项功效研究是在高度受控的、 专门的住院环境，时间很短（17 天）。 此外，在社区实践中，非典型抗精神病药利培酮已 成为 BDAD 的一线药物。为了解决持续治疗问题 在社区或疗养院（即在我们的学术环境之外），我们 建立了BDAD患者的治疗和评估体系 他们出院了。药物分配和剂量调整 将保持盲法，并对患者进行仔细监测。此外 对结果的临床和行为评估，拟议的研究还将 检查治疗反应是否与个体间相关 血清素转运蛋白启动子、血清素 2N2C 的等位基因变异 受体和CYP2D6药物代谢同工酶。药物血浆浓度监测 将用于评估由于以下原因导致的药物暴露差异的影响 依从性或药物清除率的偏差。

项目成果

Population pharmacokinetics in geriatric psychiatry.

老年精神病学中的群体药代动力学。

• 发表时间: 2006-12
• 作者: Bigos, Kristin L;Bies, Robert R;Pollock, Bruce G
• 通讯作者: Pollock, Bruce G

A critical appraisal of the utility of the serum anticholinergic activity assay in research and clinical practice.

对血清抗胆碱能活性测定在研究和临床实践中的实用性进行严格评估。

• 发表时间: 2002
• 作者: Carnahan, Ryan M;Lund, Brian C;Perry, Paul J;Pollock, Bruce G
• 通讯作者: Pollock, Bruce G

Citalopram: a comprehensive review.

西酞普兰：全面审查。

• 发表时间: 2001-04
• 影响因子: 3.2
• 作者: Pollock; B G
• 通讯作者: B G

MAP Bayesian modelling combining striatal dopamine receptor occupancy and plasma concentrations to optimize antipsychotic dose regimens in individual patients.

MAP 贝叶斯模型结合纹状体多巴胺受体占用和血浆浓度来优化个体患者的抗精神病药物剂量方案。

• 发表时间: 2022-07
• 影响因子: 3.4
• 作者: Ismail, Mohamed;Straubinger, Thomas;Uchida, Hiroyuki;Graff;Nakajima, Shinichiro;Suzuki, Takefumi;Caravaggio, Fernando;Gerretsen, Philip;Mamo, David;Mulsant, Benoit H;Pollock, Bruce G;Bies, Robert
• 通讯作者: Bies, Robert

A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia.

西酞普兰和利培酮治疗与痴呆相关的行为和精神症状的双盲比较。

• 发表时间: 2007-11
• 作者: Pollock, Bruce G;Mulsant, Benoit H;Rosen, Jules;Mazumdar, Sati;Blakesley, Richard E;Houck, Patricia R;Huber, Kimberly A
• 通讯作者: Huber, Kimberly A