BACKGROUND: Despite modest efficacy, unpredictable individual utility, and a high rate of adverse effects, behavioural and psychological symptoms of dementia (BPSD) are common determinants for antipsychotic drug therapy in nursing home patients. AIMS: To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia. METHODS:Fifty-five patients (43 women; mean age 84.1) takinghaloperidol, risperidone, or olanzapine for BPSD were randomly assigned to cessation (intervention group, n=27) or continued treatment with antipsychotic drugs (reference group, n=28) for 4 consecutive weeks. The Neuropsychiatric Inventory (NPI) Questionnaire was used to examine changes in behavioural and psychological symptoms. RESULTS: By study completion, 23 of the 27 intervention group patients were still off antipsychotics. Symptom scores (NPI) remained stable or even improved in 42 patients (intervention group, 18 out of 27; reference group, 24 out of 28; p=0.18). As compared to patients with stable or improved symptom scores, patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline (p=0.42). CONCLUSION: A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD, do well without this treatment. Standardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals.
RCT Entities:
BACKGROUND: Despite modest efficacy, unpredictable individual utility, and a high rate of adverse effects, behavioural and psychological symptoms of dementia (BPSD) are common determinants for antipsychotic drug therapy in nursing home patients. AIMS: To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia. METHODS: Fifty-five patients (43 women; mean age 84.1) taking haloperidol, risperidone, or olanzapine for BPSD were randomly assigned to cessation (intervention group, n=27) or continued treatment with antipsychotic drugs (reference group, n=28) for 4 consecutive weeks. The Neuropsychiatric Inventory (NPI) Questionnaire was used to examine changes in behavioural and psychological symptoms. RESULTS: By study completion, 23 of the 27 intervention group patients were still off antipsychotics. Symptom scores (NPI) remained stable or even improved in 42 patients (intervention group, 18 out of 27; reference group, 24 out of 28; p=0.18). As compared to patients with stable or improved symptom scores, patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline (p=0.42). CONCLUSION: A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD, do well without this treatment. Standardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals.
Authors: Lise M Bjerre; Barbara Farrell; Matthew Hogel; Lyla Graham; Geneviève Lemay; Lisa McCarthy; Lalitha Raman-Wilms; Carlos Rojas-Fernandez; Samir Sinha; Wade Thompson; Vivian Welch; Andrew Wiens Journal: Can Fam Physician Date: 2018-01 Impact factor: 3.275
Authors: Lise M Bjerre; Barbara Farrell; Matthew Hogel; Lyla Graham; Geneviève Lemay; Lisa McCarthy; Lalitha Raman-Wilms; Carlos Rojas-Fernandez; Samir Sinha; Wade Thompson; Vivian Welch; Andrew Wiens Journal: Can Fam Physician Date: 2018-01 Impact factor: 3.275
Authors: Jennifer Tjia; Marcus M Reidenberg; Jacob N Hunnicutt; Kelli Paice; Jennifer L Donovan; Abir Kanaan; Becky A Briesacher; Kate L Lapane Journal: Consult Pharm Date: 2015-10