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Ya hemos repasado

Ya hemos repasado. Función cerebral Neurotrasmisores Nuevos diagnósticos demencia Criterios demencia UMAG/criterios clínicos Protocolo IACEs/memantina. Todo lo que has querido y te ha dado pereza leer sobre. ANTIDEPRESIVOS. Dr Oscar Macho Pérez Unidad psicogeriatría

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Ya hemos repasado

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  1. Ya hemos repasado • Función cerebral • Neurotrasmisores • Nuevos diagnósticos demencia • Criterios demencia • UMAG/criterios clínicos • Protocolo IACEs/memantina

  2. Todo lo que has querido y te ha dado pereza leer sobre ANTIDEPRESIVOS Dr Oscar Macho Pérez Unidad psicogeriatría Servicio geriatría CSG 01/03/2012

  3. Major Depressive Disorder Mechanisms of Disease Belmaker R.H., Agam G. N Engl J Med 2008;358:55-68.

  4. Depression–dementia medius: Between depression andthe manifestation of dementia symptoms Kobayashi T, Kato S. Psychogeriatrics 2011; 11: 177–182

  5. depressiontreatmentis risk factor for dementia dementia & depression share common risk factors depression is a prodrome of dementia depression is early reaction cognitive decline depression affects threshold of manifesting dementia Depression is a causal factor in dementia

  6. Tests for the evaluation of depression in the elderly: A systematic review Colasanti V, Marianetti M, Micacchi F, Amabile GA, Mina C. Archives of Gerontology and Geriatrics 50 (2010) 227–230

  7. Hamilton-17: gold standard GDS no sirve para evaluar terapia farmacológica

  8. Depression in older people in the general hospital: a systematic review of screening instruments DENNIS M, KADRI A, COFFEY J Age and Ageing 2012; 41: 148–154

  9. The GDS would appear the most validated instrument currently (in either 15 or 30 item versions)

  10. Evidence-Based Guideline Detection of Depression in OlderAdults with Dementia Brown EL, Raue PJ, Halpert KD. J Gerontol Nurs. 2009 February ; 35(2): 11–15.

  11. MMSE <15 CSDD (Cornell) >11 MMSE 23-15 GDS-15 >6 MMSE >23 igual a adultos (HAM-17)

  12. Sertraline for the treatment of depression in Alzheimer’s disease: Week-24 outcomes Weintraub, D, et al. For the DIADS-2 Research Group Am J Geriatr Psychiatry. 2010 April; 18(4): 332–340.

  13. Sertraline treatment is not associated with delayed improvement between 12 and 24 weeks of treatment and may not be indicated for the treatment of depression of AD

  14. Sertraline or mirtazapine for depression in dementia(HTA-SADD): a randomised, multicentre, double-blind,placebo-controlled trial Banerjee S, Hellier J, Dewey M et al. Lancet 2011; 378: 403–1

  15. Because of the absence of benefi t compared with placebo and increased risk of adverse events, the present practice of use of these antidepressants, with usual care, for fi rst-line treatment of depression in Alzheimer’s disease should be reconsidered.

  16. Antidepressant Drug Effectsand Depression SeverityA Patient-Level Meta-analysis Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J. JAMA. 2010;303(1):47-53

  17. The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial. Punto corte HDRS 25

  18. Antidepressants for agitation and psychosis in dementia. Seitz DP, Adunuri N, Gill SS., Gruneir A, Herrmann N, Rochon P. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008191

  19. The SSRIs sertraline and citalopram were associated with a modest reduction in symptoms of agitation and psychosis when compared to placebo in two studies.

  20. There were few other statistically significant differences in changes in agitation or psychosis or in most measures of medication tolerability for SSRIs or trazodone when compared to placebo or the antipsychotic haloperidol.

  21. We conclude that 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.

  22. Antidepressants for treating depression in dementia Bains J, Birks J, Dening T Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD003944.

  23. It is not that antidepressants are necessarily ineffective but rather that there is not much evidence to support their efficacy. Given that they may produce serious side-effects clinicians should therefore prescribe with due caution.

  24. World Press Photo of the Year 2011by Samuel Aranda “…menos mal que con los rifles no se matan las palabras.” Extrechinato y tú. Abrazado a la tristeza

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