Rischio di mortalità con i farmaci antipsicotici nella popolazione psichiatrica anziana? Una revisione sistematica della letteratura

Titolo Rivista RIVISTA SPERIMENTALE DI FRENIATRIA
Autori/Curatori Riccardo De Giorgi, Andrea Cipriani
Anno di pubblicazione 2016 Fascicolo 2016/2
Lingua Italiano Numero pagine 24 P. 127-150 Dimensione file 225 KB
DOI 10.3280/RSF2016-002008
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FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

In Italia gli anziani raggiungono quasi un quarto della popolazione generale. In questo sottogruppo, gli antipsicotici sono ampiamente prescritti: nonostante siano autorizzati esclusivamente per schizofrenia e disturbo bipolare, è assai frequente l’uso off-label in demenza, delirium, ed altri disturbi. Un’ampia letteratura ha osservato un’associazione tra rischio di mortalità ed esposizione ad antipsicotici nella popolazione anziana con demenza, supportando la pubblicazione di black box warnings da parte della Food and Drug Administration negli Stati Uniti, secondo un percorso poi seguito dagli altri Paesi. Tuttavia, non è chiaro se tale associazione sia causale, così come se sia applicabile anche a pazienti anziani non affetti da demenza. Questo studio si pone l’obiettivo di revisionare sistematicamente la letteratura riguardante il rischio di mortalità nella popolazione geriatrica affetta da psicosi dello spettro schizofrenico e bipolare, demenza e delirium. È stata condotta una ricerca sistematica sui database MEDLINE e Cochrane Library, includendo quegli studi riguardanti la valutazione del rischio di mortalità in soggetti di 65 o più anni trattati con antipsicotici di prima e/o seconda generazione. In totale, 25 pubblicazioni soddisfacevano i criteri d’inclusione per questa revisione sistematica: 3 per psicosi in schizofrenia e disturbo bipolare, 20 per demenze, e 2 per delirium. Sebbene non sia possibile rifiutare l’ipotesi di un soggiacente meccanismo fisiopatologico comune alla condizione "vecchiaia", comportante un maggiore rischio di mortalità a seguito dell’esposizione a farmaci antipsicotici, è innegabile che anche la patologia neuropsichiatrica di base abbia una sua influenza, sia essa positiva o negativa, su tale rapporto. La corretta valutazione dei fattori di rischio individuali può aiutare a prendere decisioni condivise tra clinico e paziente verso scelte terapeutiche più efficaci, sicure, e soprattutto più appropriate.;

Keywords:Antipsicotici, mortalità, anziani, psicogeriatria, revisione sistematica.

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Riccardo De Giorgi, Andrea Cipriani, Rischio di mortalità con i farmaci antipsicotici nella popolazione psichiatrica anziana? Una revisione sistematica della letteratura in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2016, pp 127-150, DOI: 10.3280/RSF2016-002008