Use of Tiapride in the Treatment of Behavioral Disorders in Geriatric Patients
Hand in hand with the increasing number of people reaching an older age, there is also a rise in the occurrence of dementia. It affects the lives of patients and their families in many ways. A significant problem can be behavioral disorder, which needs to be treated adequately and promptly to prevent issues such as injuries.
Behavioral disorders in patients with dementia
In patients suffering from dementia, regardless of its etiology, there can be a disruption in one or more of the three basic areas of thinking and behavior—changes in cognitive functions, daily activities, and behavior or emotions. Especially the latter group, sometimes referred to as behavioral and psychological symptoms of dementia (BPSD, e.g., pacing, wandering, verbal or physical aggression, or conversely apathy, delusions), can be a crucial reason for promptly addressing social issues requiring increased family supervision or institutional care.
Behavioral disorders can be triggered or worsened by a variety of factors, whether it be psychological discomfort, sensory or motor deprivation, metabolic disorders, infections, dehydration, inadequate nutrition, or iatrogenic causes such as inappropriate pharmacotherapy (particularly in older patients with extensive medication histories) or poorly managed pain. First and foremost, it is important to rule out secondary behavioral disorders stemming from removable somatic causes.
Use of antipsychotics in agitated patients
However, treating the cause and adopting a non-pharmacological approach is not always sufficient. In agitated and difficult-to-manage patients, it is often necessary to intervene with sedative medication, most commonly antipsychotics. These are the treatment of choice in restless, agitated, and aggressive patients, not only with schizoaffective psychoses but also in patients with organic psychosyndrome or acute stress reactions. In patients with dementia, antipsychotics are used to control BPSD. Given that patients become increasingly sensitive to extrapyramidal side effects with age, second-generation antipsychotics, formerly known as atypical antipsychotics or neuroleptics, are preferable.
A suitable preparation for calming psychomotor agitation is the well-proven and readily available tiapride. Through its prompt effect on dopamine D2 receptors in the brain, especially when administered parenterally, it quickly induces calming and is used as a so-called chemical restraint. Tiapride shows an antipsychotic effect only with regular long-term administration. It is available in tablets, drops, and injectable forms and is well tolerated, making it very often the first-choice medication for acute and long-term management of psychomotor agitation.
The average dose for the geriatric population is 200 mg per day, with a maximum dose in this indication being 300 mg per day. Treatment should be initiated at a dose of 50 mg twice daily and incrementally increased by 50–100 mg every 2–3 days according to the principle of start low, go slow.
Conclusion
In the treatment of psychomotor agitation, second-generation antipsychotics are becoming the drug of choice due to their broader therapeutic index and good tolerability. From this heterogeneous group, tiapride can be advantageously used in practice, available in all main forms of application, having a good pharmacological profile and minimal side effects.
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Sources:
1. Kopeček M. Clinical and theoretical aspects of antipsychotic (neuroleptic) administration. Remedia 2002; 12 (6): 447–465.
2. Jirák R. Behavioral and mood disorders in dementia. Psychiatry for practice 2011; 12 (2): 56–60.
3. SPC Tiapridal. Available at: www.sukl.cz/modules/medication/detail.php?kod=0048578
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