[Use of antidepressants in institutionalized patients with dementia and agitation: Case reports]. / Uso de antidepresivos en pacientes institucionalizados con demencia y agitación: reporte de casos.

Psychological and behavioral symptoms in dementias are frequent: they affect 90% of patients at some point in the evolution of the disease. Their presence determines in general the institutionalization of the person. Also, in that context, it may lead to an abusive prescription of antipsychotics, despite little evidence regarding its effcacy and adverse effects profle. Following this line, the objective of this work will focus on the "use" and "utility" of an under-examined pharmacological class in agitated patients with dementia: antidepressants. We will share a clinical experience from the report of ten cases of institutionalized patients.

[PERSONALITY DISORDERS AND GERIATRIC INSTITUTION]. / Los trastornos de personalidad y la institución geriatric.

Nursing Homes house a large number of residents with some kind of psychiatric disorder. The most complex cases are those involving personality disorders; these, known as difficult residents, often imply a challenge to the institution in every aspect and have a strong impact on the staff and on other residents. The present article considers the relevant aspects of personality disorders in the nursing home, with the nursing home, and from the nursing home, taking into account the difficulties presented by these personalities when faced aging. Moreover, possible approaches to these residents are proposed.

[Antipsychotics in geriatric institutions]. / Los antipsicóticos en las instituciones geriátricas.

The present paper approaches the use of antipsychotics in elder people in general, and particularly in geriatric institutions. During the last few years, prescription of antipsychotics in geriatric institutions increased, especially because of the availability of the atypicals, and their use was extended beyond the indications these drugs had been approved for. In dementia they are suggested for treatment of behavioral symptoms, despite having been approved only for cases of aggressiveness and risk of damage. There is a common tendency of perpetuating antipsychotic medication in elder people, with its consequent collateral effects as well. Few years ago, the increase of both risk of cerebrovascular events and of mortality in dementia patients treated with atypical agents was noticed. This generated controversy regarding their use in those kind of patients. Diverse factors associated to caregivers affect the decision of prescribing an antipsychotic in elder people. Non-pharmacological interventions are the first choice when treating behavioral symptoms; pharmacological interventions must take place with the lowest doses possible, with limited durations.