Antipsychotic Discontinuation in Patients with Dementia: A Systematic Review and Meta-Analysis of Published Randomized Controlled Studies

Pan, Yi‐Ju; Wu, Chi‐Shin; Gau, Susan Shur‐Fen; Chan, Hung‐Yu; Banerjee, Sube

doi:10.1159/000355418

Cited by 34 publications

(35 citation statements)

References 66 publications

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“…Some NH antipsychotic deprescribing studies have generated encouraging results [40, 41] although one study did report an increase in neuropsychiatric symptoms in the intervention group [42]. Further interventions emphasize deprescribing of antipsychotics for neuropsychiatric symptoms of dementia.…”

Section: Discussionmentioning

confidence: 99%

The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study

Wilchesky

Muêller²,

Morin

et al. 2018

BMC Geriatr

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BackgroundMedication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either “generally”, “sometimes” or “exceptionally” appropriate for NH residents with severe dementia.MethodsA quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents’ families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran’s-Q tests.ResultsThe KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a “sometimes appropriate” medication post-intervention were 0.81 (95% CI: 0.71–0.92) and 0.83 (95% CI: 0.74–0.94), respectively.ConclusionA simple KE intervention using a medication review guidance tool categorizing medications as being either “generally”, “sometimes” or “exceptionally” appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0895-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study

Wilchesky

Muêller²,

Morin

et al. 2018

BMC Geriatr

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“…Además de la amnesia y el deterioro funcional pueden aparecer síntomas conduc- tuales y neuropsiquiátricos, como delírium, agitación o trastornos de conducta. La prevalencia de estos síntomas puede alcanzar el 50% en los pacientes con demencia, lo que constituye un factor predisponente para la hospitalización o institucionalización de los pacientes, además de una fuente de estrés importante para pacientes y cuidadores 63 . Los antipsicóticos se recomiendan para manejar los síntomas conductuales y neuropsiquiátricos solo después de abordar los posibles factores precipitantes (como pueden ser infecciones, efectos secundarios a medicamentos, dolor, etc.)…”

Section: Antipsicóticos En Pacientes Con Demenciaunclassified

“…Sin embargo, dos recientes metaanálisis solo identificaron 9 ensayos clínicos controlados (606 pacientes) que evaluaron el efecto de la retirada de antipsicóticos en pacientes con demencia, la mayoría de ellos institucionalizados 63,66 . Estos dos metaanálisis concluyen que los antipsicóticos pueden retirarse en muchos pacientes sin efectos perjudiciales.…”

Section: Evidencias En Retirada De Antipsicóticosunclassified

“…Además, otros dos estudios encontraron que los pacientes con síntomas neuropsiquiátricos graves pueden beneficiarse del tratamiento continuado con antipsicóticos. Algunos factores predictores de peor respuesta a su retirada son el uso de benzodiazepinas y el empleo de dosis altas de antipsicóticos 63 . En la tabla 8 se recogen las principales cuestiones que deben tenerse en cuenta para la deprescripción de antipsicóticos (motivos para la retirada, población susceptible, consejos para la retirada y problemas que acarrea su suspensión) [69][70][71][72] .…”

Section: Evidencias En Retirada De Antipsicóticosunclassified

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Deprescripción de medicamentos

Bueno¹,

Hernández²,

Herrero³

et al. 2015

FMC - Formación Médica Continuada en Atención Primaria

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“…Alzheimer’s disease (AD) is the most common causes of dementia and is characterized by core symptoms such as cognitive deficits and behavioral and psychological symptoms of dementia (BPSD) such as aggression, hallucinations, disturbed behavior, and agitation [20]. BPSD are a serious problem for caregivers; there is a positive correlation between their severity and the care burden.…”

Section: Introductionmentioning

confidence: 99%

Influences of yokukansankachimpihange on aggressive behavior of zinc-deficient mice and actions of the ingredients on excessive neural exocytosis in the hippocampus of zinc-deficient rats

et al. 2016

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We examined the effect of Yokukansankachimpihange (YKSCH), a form of Yokukansan containing parts of two herbaceous plants, Citrus Unshiu Peel (Chimpi) and Pinellia Tuber (Hange), on aggressive behavior of mice housed individually. Mice were fed a zinc-deficient diet for 2 weeks. In a resident-intruder test, the cumulative duration of aggressive behavior was decreased in zinc-deficient mice administrated drinking water containing YKSCH (approximately 300 mg/kg body weight/day) for 2 weeks. We tested mice for geissoschizine methyl ether (GM), which is contained in Uncaria Hook, and 18β-glycyrrhetinic acid (GA), a major metabolite of glycyrrhizin contained in Glycyrrhiza, which were contained in YKS and YKSCH. In hippocampal slices from zinc-deficient rats, excess exocytosis at mossy fiber boutons induced with 60 mM KCl was attenuated in the presence of GA (100–500 µM) or GM (100 µM). The intracellular Ca2+ level, which showed an increase induced by 60 mM KCl, was also attenuated in the presence of GA (100–500 µM) or GM (100 µM). These results suggest that GA and GM ameliorate excess glutamate release from mossy fiber boutons by suppressing the increase in intracellular Ca2+ signaling. These ameliorative actions may contribute to decreasing the aggressiveness of mice individually housed under zinc deficiency, potentially by suppressing excess glutamatergic neuron activity in the hippocampus.

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Antipsychotic Discontinuation in Patients with Dementia: A Systematic Review and Meta-Analysis of Published Randomized Controlled Studies

Cited by 34 publications

References 66 publications

The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study

The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study

Deprescripción de medicamentos

Influences of yokukansankachimpihange on aggressive behavior of zinc-deficient mice and actions of the ingredients on excessive neural exocytosis in the hippocampus of zinc-deficient rats

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