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Roach P, Lovell MR, Macfarlane S. Dying with behavioral and psychological symptoms of dementia in Australian nursing homes: a retrospective case-control study. Front Psychiatry 2023; 14:1091771. [PMID: 37255681 PMCID: PMC10225542 DOI: 10.3389/fpsyt.2023.1091771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
Objectives To identify predictors of mortality in people with active and challenging behavioral and psychological symptoms of dementia (BPSD). Design A retrospective case-control study was designed to compare those referred to Dementia Support Australia (DSA) who died in the 12 months to November 2016, with an equal number of controls who did not die. An audit tool was designed after literature review and expert opinion from the service. Odds ratio calculations and the Mann-Whitney U test were used to assess for difference. Setting Residents of Australian residential aged care facilities with BPSD referred to the DSA service. Participants Of 476 patients referred to DSA during the study period, 44 died. 44 controls were randomly selected from those remaining matched for age and sex. Results Significant differences included higher rates of benzodiazepine use, drowsiness, delirium, reduced oral intake and discussions about goals of care in those who died. Those who died were referred to the service for a shorter period and had more frequent contact between DSA and nurses at the nursing homes. Increase in opioid use and loss of skin integrity in those who died approached significance. The overall end of life course demonstrated a complex set of needs with frequent delirium, pain and frailty. Conclusion Further study is required to determine the optimal care for those with BPSD at the end of their lives. This study would indicate complex end of life care needs and point to a role for palliative care support.
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Affiliation(s)
- Peter Roach
- Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
- Mona Vale Hospital, Northern Sydney Local Health District, Mona Vale, NSW, Australia
| | - Melanie R. Lovell
- Greenwich Hospital, HammondCare, Greenwich, NSW, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, St Leonards, NSW, Australia
| | - Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
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Zhou J, Guo C, Ren L, Zhu D, Zhen W, Zhang S, Zhang Q. Gender differences in outpatients with dementia from a large psychiatric hospital in China. BMC Psychiatry 2022; 22:208. [PMID: 35313835 PMCID: PMC8935692 DOI: 10.1186/s12888-022-03852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sociodemographic characteristics and clinical features of dementia patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of dementia patients at a psychiatric hospital in China, with particular emphasis on gender differences. METHODS This retrospective study examined outpatients with dementia from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records. RESULTS Nine thousand four patients were recruited from a specific outpatient clinic of a hospital in Beijing, and the mean number of visits was 6.92. There were 3,433 (38.13%) male patients and 5,571 (61.87%) female patients. The most common comorbidities were generalized anxiety disorder, nonorganic insomnia, delusional disorder and depressive disorder. The proportion of patients using antidementia was the highest, with the rate of 68.3%, followed by benzodiazepines (48.83%), antipsychotics (45.43%), antidepressants (22.24%) and nonbenzodiazepines (19.96%). Patients with dementia showed a significant gender difference in average age (t = 6.36, P < 0.0001). Compared to male patients, female patients had a higher number of visits (7.40 ± 12.90 vs 6.15 ± 10.50, t = 4.81, P < 0.0001). There were significant differences in comorbidity composition between male and female patients (t = 23.09, P < 0.0001). CONCLUSIONS Our present findings suggested significant gender differences in the proportion of age, number of visits and comorbidity composition in outpatients with dementia.
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Affiliation(s)
- Jiaojiao Zhou
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Chengwei Guo
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Li Ren
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Dandi Zhu
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Wenfeng Zhen
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Saina Zhang
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Qing’e Zhang
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
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3
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Tan SX, Cameron SC, Sam LM, Eigeland H, Hay K, Eeles E, Natarajan K. A delicate balance: Psychotropic polypharmacy and anti-cholinergic use are correlated with fall incidence in Australian inpatients with dementia. Aging Med (Milton) 2021; 4:193-200. [PMID: 34553116 PMCID: PMC8444955 DOI: 10.1002/agm2.12175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Persons with dementia commonly experience a range of behavioural and psychological symptoms, including agitation, aggression, perceptual disturbances, and depression. While psychotropic medications are regularly prescribed to mitigate these symptoms, these agents also carry a broad adverse effect profile. This study aimed to characterize psychotropic medication use in patients with dementia, as well as identify prescribing factors associated with falls in this cohort. METHODS This retrospective study collected longitudinal demographic and medication data from all patients admitted to a neuro-cognitive unit at an Australian metropolitan hospital over a 2-year period. Psychotropic polypharmacy and psychotropic agent use per patient-fortnight were investigated for their association with inpatient falls. RESULTS All patients (n = 147) were prescribed at least one psychotropic medication, with 96% receiving anti-psychotic medications and 90% receiving benzodiazepines. Patient fall rate was significantly associated with anticholinergic drug use (Incidence rate ratio: 2.2; P < .001), as well as concomitant use of ≥5 daily psychotropic agents (Incidence rate ratio: 3.1; P = .001). CONCLUSIONS Patients with dementia are routinely prescribed a wide variety of psychotropic medications. Use of anticholinergic drugs and psychotropic polypharmacy are correlated with fall incidence in persons with dementia.
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Affiliation(s)
- Samuel X. Tan
- Princess Alexandra HospitalBrisbaneQLDAustralia
- The Prince Charles HospitalBrisbaneQLDAustralia
| | | | - Lit Min Sam
- Princess Alexandra HospitalBrisbaneQLDAustralia
| | | | - Karen Hay
- QIMR Berghofer Institute of Medical ResearchBrisbaneQLDAustralia
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4
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Zhang Y, Luo H, Wong GHY, Zhao M, Lv X, Lum TYS, Chui CSL, Yu X, Wong ICK, Wang H. Prescription Patterns of Antidementia and Psychotropic Drugs in People Living With Dementia: Findings From the Clinical Pathway Study of Alzheimer's Disease in China. J Am Med Dir Assoc 2021; 23:1073-1079.e3. [PMID: 34418377 DOI: 10.1016/j.jamda.2021.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Evidence about prescribing patterns of dementia medication in China is lacking. This study aimed to examine prescribing rates of antidementia and psychotropic drugs and factors associated with drug prescription for dementia in China. DESIGN A multicenter observational study. SETTING AND PARTICIPANTS This study employed cross-sectional data from the Clinical Pathway for Alzheimer's Disease in China study that was conducted in 28 memory clinics at tertiary hospitals across 14 provinces between 2012 and 2013. Patients aged ≥45 years with a diagnosis of dementia were included. METHODS Antidementia and psychotropic drugs were classified according to the Anatomical Therapeutic Chemical codes. Odds ratios (ORs) of putative factors associated with prescription patterns were estimated using logistic regressions. RESULTS A total of 751 respondents were included in this study, 77.8% of whom were prescribed antidementia drugs, and 33.0% were prescribed at least 1 psychotropic drug. The concomitant prescription rate of antidementia and psychotropic drugs was 24.1%. Frontotemporal dementia [OR 9.92 (99.17% CI 3.08-42.70)], severe dementia [4.25 (1.88-9.79)], and apathy [1.94 (1.18-3.20)] were significantly associated with an elevated likelihood of memantine prescription. Psychotic symptoms [1.84 (1.02-3.35)], agitation [1.91 (1.08-3.40)], and depressive symptoms [2.10 (1.12-3.94)] were significantly associated with the coprescription of antidementia and psychotropic agents. CONCLUSIONS AND IMPLICATIONS The prescribing rate of antidementia drugs in the study sample was higher, whereas the rate of coprescription of psychotropic and antidementia drugs was lower than reported in Western studies. Dementia prescription practice was generally consistent with clinical guidelines in memory clinics in China, whereas the prescription of antidementia and psychotropic medication mainly depended on patients' clinical symptoms.
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Affiliation(s)
- Yingyang Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Department of Computer Science, The University of Hong Kong, Hong Kong, China; Aging Research Center, Karolinska Institutet, Stockholm, Sweden; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China.
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Mei Zhao
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China
| | - Xiaozhen Lv
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China; Key Laboratory for Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Terry Y S Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Celine S L Chui
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong SAR, Hong Kong, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Xin Yu
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China; Key Laboratory for Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Ian C K Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Huali Wang
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China; Key Laboratory for Mental Health, Ministry of Health (Peking University), Beijing, China.
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Ito E, Berge LI, Husebo BS, Nouchi R, Sandvik RK. The Negative Impact of Psychotropic Drug Use on Quality of Life in Nursing Home Patients at Different Stages of Dementia: Cross-Sectional Analyses from the COSMOS Trial. J Am Med Dir Assoc 2020; 21:1623-1628. [DOI: 10.1016/j.jamda.2020.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
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Sex-based pharmacotherapy in acute care setting, a narrative review for emergency providers. Am J Emerg Med 2020; 38:1253-1256. [PMID: 32173235 DOI: 10.1016/j.ajem.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Sex-based medicine, which can be defined as the process of understanding the inherent differences in disease pathophysiology and response to medications that exist between the sexes, seems like a necessary step in the movement towards personalized medicine. While there are strict guidelines for weight-based dosage of pediatric medications, similar guidelines do not exist for the treatment of adults, despite prominent biologic differences between the sexes. The lack of individualization is of particular importance in the treatment of adult patients in the emergency department (ED), because it can determine the trajectory of a patient's stay at the hospital. OBJECTIVES This review was conducted to better understand the need for and possible benefits of altering drug dosing guidelines for different categories of medications in the ED. PubMed, SCOPUS, and Google Scholar were queried using a combination of the keywords "gender differences," "sex differences," "treatment," and "emergency". Abstracts, unpublished data, and duplicate articles were excluded. DISCUSSION In considering some of the most common causes of ED visits, the majority of diseases demonstrate differences in morbidity and mortality between female and male patients, despite similar treatment regimens. These differences can be attributed to variations in drug pharmacodynamics and pharmacokinetics, which may be affected by sex-based biologic variations in body mass index and body composition, and physiologic variations such as hormonal changes, menstruation, pregnancy, and lactation. Regardless of the mechanism of these differences, there is overwhelming evidence that universal drug dosing results in suboptimal outcomes for both male and female patients. CONCLUSIONS Female sex is a risk factor for clinically significant adverse drug reactions, which range from cutaneous reactions to major bleeding, and can have long-standing implications on patient outcomes. However, future studies are needed to understand the exact pathophysiology of these sex differences, after controlling for potential confounding factors such as demographic differences and provider bias in treatment.
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Description of the Treatment Course by Pregabalin for Anxiety in Patients With a Major Neurocognitive Disorder. J Clin Psychopharmacol 2019; 39:261-263. [PMID: 30939590 DOI: 10.1097/jcp.0000000000001029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anxiety symptoms frequently experienced by patients with a major neurocognitive disorder (NCD) are often treated with long-term benzodiazepines despite known adverse effects. Pregabalin has shown efficacy in generalized anxiety disorders but has not been studied in patients with a major NCD. The objective of this study was to describe the use of pregabalin for anxiety in patient with a major NCD and the impact of its use on the pharmacological treatment change. METHODS A retrospective study was conducted using data of hospitalized patients in a cognitive-behavioral specialized unit between January 2015 and December 2017. Patients with a major NCD treated by pregabalin were included in this study. Data about the use of pregabalin (initiation and effective dosage, titration duration) and the use of other psychotropics were collected from the patients' medical records. RESULTS Thirty-three patients were included (mean age, 79.6 ± 11.7 years; 66.7% women). The mean duration of pregabalin titration was 18.6 ± 1.4 days, and the mean effective dosage was 200.0 ± 130.8 mg/d (range, 50-700 mg/d). At admission (before pregabalin use), 78.8% of patients were treated with a systematic prescription of benzodiazepine. At discharge (with pregabalin use), a significant decrease in patients with systematic prescription of benzodiazepine was observed (78.8% vs 33.3%, P = 0.001). During hospitalizations, no pregabalin treatment has been discontinued for lack of efficacy or for tolerance. CONCLUSIONS Larger controlled studies are needed to confirm the efficacy and the safety of pregabalin to treat anxiety symptoms associated with neurocognitive disorders.
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8
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Seeman MV, González-Rodríguez A. Use of psychotropic medication in women with psychotic disorders at menopause and beyond. Curr Opin Psychiatry 2018. [PMID: 29528895 DOI: 10.1097/yco.0000000000000410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Drugs have been extensively prescribed for the treatment of psychotic symptoms in schizophrenia and related disorders, as well as for the management of psychotic features in delirium, dementia and affective disorders. The aim of this narrative review is to focus on the recent literature on drug treatment in women with psychosis at the transition to menopause and subsequently. RECENT FINDINGS The recent literature emphasizes the following points: the efficacy of antipsychotic medication in psychosis is largely confined to the alleviation of delusions and hallucinations; menopause and ageing alter the kinetics and dynamics of drug action; drugs other than antipsychotics are currently being tested to address the cognitive, affective and negative symptoms of psychotic illnesses; menopausal symptoms add to comorbidities and require simultaneous treatment, raising the probability of deleterious drug interactions; antipsychotic drugs have many side effects and contribute to high mortality rates in the older psychosis population. SUMMARY A major implication for research is that antipsychotic drugs with a wider range of action and with fewer side effects are urgently needed. The clinical implications of the pharmacotherapy of psychotic illness are: older women's needs must be assessed through a comprehensive history and review of systems and physical and mental examination. To avoid adverse effects, drug dosages are best kept low and polypharmacy avoided wherever possible. It is important to frequently reassess older patients, as their pharmacotherapy requirements change with age and with comorbidity.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Saarelainen L, Tolppanen AM, Koponen M, Tanskanen A, Tiihonen J, Hartikainen S, Taipale H. Risk of death associated with new benzodiazepine use among persons with Alzheimer disease: A matched cohort study. Int J Geriatr Psychiatry 2018; 33:583-590. [PMID: 29143367 DOI: 10.1002/gps.4821] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/27/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the risk of death associated with new benzodiazepine and related drug (BZDR) use in a nationwide cohort of persons with Alzheimer disease (AD). METHODS The register-based MEDALZ cohort, including all community-dwelling Finns diagnosed with AD during 2005 to 2011 (n = 70 718), was used. Clinically verified AD diagnoses were obtained from the Special Reimbursement Register. Drug use periods were modeled from BZDR purchases, derived from the Prescription Register. To study new users, persons who had any BZDR use during the year preceding the AD diagnosis were excluded. For each person initiating BZDR use (n = 10 380), 2 nonusers (n = 20 760) were matched on age, gender, and time since AD diagnosis. The outcome was 180-day mortality, and BZDR use was compared with nonuse with Cox regression. Multivariable analyses were adjusted for Charlson comorbidity index, socioeconomic position, hip fractures, psychiatric disorders, substance abuse, stroke, and other psychotropic drug use. RESULTS During the follow-up, 5 excess deaths per 100 person-years occurred during BZDR use in comparison to nonuse, and mortality rates were 13.4 (95% confidence interval [CI], 12.2-14.5) and 8.5 (95% CI, 7.9-9.1), respectively. Benzodiazepine and related drug use was associated with an increased risk of death (adjusted hazard ratio = 1.4 [95% CI, 1.2-1.6]), and the association was significant from the initiation of use. Benzodiazepine use was associated with an increased risk of death, whereas benzodiazepine-related drug use was not. CONCLUSIONS Benzodiazepine and related drug use was associated with an increased risk of death in persons with AD. Our results support treatment guidelines stating that nonpharmacological approaches should be the first-line option for symptomatic treatment of AD.
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Affiliation(s)
- Laura Saarelainen
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Impact Assessment Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland.,Stockholm County Council, Stockholm, Sweden
| | - Sirpa Hartikainen
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre for Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ralph SJ, Espinet AJ. Increased All-Cause Mortality by Antipsychotic Drugs: Updated Review and Meta-Analysis in Dementia and General Mental Health Care. J Alzheimers Dis Rep 2018; 2:1-26. [PMID: 30480245 PMCID: PMC6159703 DOI: 10.3233/adr-170042] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
It is almost ten years since the Banerjee 2009 report established that inappropriate prescribing of antipsychotics in the elderly was occurring in the UK and such patients had an 85% increased risk of adverse events and greater mortality. This report was a critical analysis addressing the outcomes of treatment practices for dementia in UK patients and globally, aimed at reducing prescribing of antipsychotic drugs for dementia. Since 2009, many significant studies worldwide (including several more recent large retrospective studies) provide more extensive longitudinal data for the adverse impacts of antipsychotic drugs in dementia. We have used the data in these studies including from over 380,000 dementia patients, with 85,069 prescribed antipsychotic agents as well as from 359,235 non-dementia antipsychotic drug users to provide an up-dated meta-analysis. This is the first meta-analysis to include evidence from general mental health studies showing that antipsychotic drugs precipitate excessive mortality across the spectrum. Prescribing of antipsychotic drugs for dementia or for other mental health care should be avoided and alternative means sought for handling behavioral disorders of such patients.
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Affiliation(s)
- Stephen J Ralph
- School of Medical Science, Griffith University, Gold Coast, Southport, QLD, Australia
| | - Anthony J Espinet
- School of Medicine, Griffith University, Gold Coast, Southport, QLD, Australia
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