Short term courses of antipsychotic medications, when given to older adults with dimentia, are associated with a greater risk of hospitalization and death, according to a report released on May 26, 2008 in the Archives of Internal Medicine, one of the JAMA/Archives journals.

Antipsychotic drugs are used to treat various psychotic disorders -- some conventional examples include haloperidol or loxaprine. The authors point out that a new generation of these drugs has been released, but the effects of short term prescription have not yet been ascertained. "Newer antipsychotic drugs (olanzapine, quetiapine fumarate and risperidone) have been on the market for more than a decade and are commonly used to treat the behavioral and psychological symptoms of dementia," they say. "Antipsychotic drugs are often used for short periods to treat agitation in clinical practice. They are frequently prescribed around the time of nursing home admission." Approximately 17% of nursing home admission begin a regimen of antipsychotic medications, with only 10% on a single prescription. Given this information, they say, it is important to evaluate the effects of short term regimens on patients.

To investigate this issue, Paula A. Rochon, M.D., M.P.H., F.R.C.P.C., of the Institute for Clinical Evaluative Sciences (ICES), Ontario, and colleagues examined older adults living with dementia in the community and in nursing homes between 1997 and 2004. In each setting, three separate groups of equal size were identified, each differing only in their exposure to antipsychotic medications. One group had not received antipsychcotics, one group had been prescribed atypical or newer antipsychotics, and the last group was prescribed conventional psychotics. For older adults in the community, 6,894 were in each group for a total or 20,682 patients. In the older adults with dementia living in nursing homes, each group had 6,853 for a total of 20,559 subjects.

The medical records of each participant were examined, and hospital admissions and death within 30 days of the initiation of therapy were noted as serious adverse events. The team found that, in the general community, those prescribed with nonconventional antipsychotic drugs were more likely to experience adverse events, while those on conventional antipsychotic drugs were even more likely. "Relative to community-dwelling older adults with dementia who did not receive a prescription for antipsychotic drugs, similar older adults who did receive atypical antipsychotic drugs were three times more likely and those who received a conventional antipsychotic drug were almost four times more likely to experience a serious adverse event within 30 days of starting therapy." The authors continue, noting a similar but less pronounced trend in the nursing room group: "Relative to nursing home residents in the control group, individuals in the conventional antipsychotic therapy group were 2.4 times more likely to experience a serious adverse event leading to an acute care hospital admission or death. Those in the atypical antipsychotic group were 1.9 times more likely to experience a serious adverse event during 30 days of follow-up."

The precise number of adverse events may be underestimated in this study, because the length of follow-up was so short, according to the authors. Also, often, the serious events experienced by nursing home residents are taken care of within the facility, without hospital admission. Additionally, when physicians notice signs of a problem early, they may take patients off of antipsychotics. This could avoid more serious consequences. The authors indicate that this only cements the need for further research to this end. "Our results exploring serious adverse events likely identify only the 'tip of the iceberg'," they say. "Antipsychotic drugs should be prescribed with caution even for short-term therapy."

Antipsychotic Therapy and Short-term Serious Events in Older Adults With Dementia
Paula A. Rochon; Sharon-Lise Normand; Tara Gomes; Sudeep S. Gill; Geoffrey M. Anderson; Magda Melo; Kathy Sykora; Lorraine Lipscombe; Chaim M. Bell; Jerry H. Gurwitz
Arch Intern Med. 2008;168(10):1090-1096.
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Anna Sophia McKenney

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