Double‐blind controlled withdrawal of thioridazine treatment in elderly female inpatients with senile dementia

Findlay, D.J.S.; Sharma, J.; McEwen, J.; Ballinger, Brian R.; MacLennan, W. J.; McHarg, Anne M.

doi:10.1002/gps.930040210

Cited by 18 publications

(9 citation statements)

References 16 publications

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“…These findings are in accordance with other reports (Mann et al, 1986;Gilleard et al, 1983;Dehlin and FranzCn, 1985), and neuroleptic medications have become a mainstay in the treatment of the agitated elderly demented patient (Risse and Barnes, 1986). However, their usefulness has been questioned (Barnes et al, 1982;Findlay et al, 1989). Mann et al (1984 emphasize that medication tends to be higher in a nursing-medical model than in a social model of care.…”

Section: Discussionmentioning

confidence: 99%

Mental and physical capacity and consumption of neuroleptic drugs in residents of nursing homes

Nygaard¹,

Bakke

Breivik³

et al. 1990

Int J Geriat Psychiatry

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SUMMARYThe mental and physical capacity of all persons living permanently in a nursing home in Bergen were estimated and their neuroleptic drug consumption and duration of stay were registered. Fifty-one per cent were severely and 14% moderately mentally impaired. Eighty-seven per cent demanded more extensive nursing care. Physical dependence was significantly associated with mental decline, but not with age. 32.6% received regularly neuroleptic medication, which was most common among restless and wandering residents. Dosage fell with increasing age and decreasing ability to perform personal hygiene.

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Section: Discussionmentioning

confidence: 99%

Mental and physical capacity and consumption of neuroleptic drugs in residents of nursing homes

Nygaard¹,

Bakke

Breivik³

et al. 1990

Int J Geriat Psychiatry

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“…From these 47 studies, 29 were excluded because they were part of an educational program to reduce antipsychotic prescription, 7 were excluded because of the observational study design and 1 was excluded because 2 studies [18,25] were the same study with a different follow-up period and outcomes reporting. Therefore, 10 studies [18,19,21,22,23,24,26,35,36,37] were entered into the qualitative data synthesis. Among the studies in the qualitative data synthesis, 1 study [35] was excluded from the meta-analysis because the medication discontinuation combined antipsychotics and other psychotropic medications and did not report the results separately.…”

Section: Resultsmentioning

confidence: 99%

“…Among the studies in the qualitative data synthesis, 1 study [35] was excluded from the meta-analysis because the medication discontinuation combined antipsychotics and other psychotropic medications and did not report the results separately. Finally, 9 studies [18,19,21,22,23,24,26,36,37] were entered into a meta-analysis. Each of the 9 studies can only provide some, but not all, data for different outcome variables.…”

Section: Resultsmentioning

confidence: 99%

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

Pan¹,

Gau

et al. 2013

Dement Geriatr Cogn Disord

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Background: There is a lack of clarity in the literature on the impact of antipsychotic discontinuation in dementia. Method: We conducted a systematic review and meta-analysis of published randomized controlled studies comparing the effects of antipsychotic discontinuation versus continuation in dementia. MEDLINE, EMBASE, PsycInfo, Cochrane Library and CINAHL were searched. Severity change of behavioral and psychological symptoms of dementia (BPSD) was the primary outcome. Results: Ten studies were included in the systematic review and 9 studies in the meta-analysis. The results showed that the antipsychotic discontinuation group had no statistically significant difference in BPSD severity change compared to the continuation group (n = 214, standardized mean difference: 0.19, 95% CI: -0.20 to 0.58). Secondary outcome analyses revealed that the discontinuation group included a statistically significantly higher proportion of subjects whose BPSD severity worsened (n = 366, risk ratio: 1.78, 95% CI: 1.31-2.41). Although not statistically significant, the discontinuation group appeared to have higher early study termination rates and a lower mortality during follow-up. Conclusions: This meta-analysis showed that antipsychotic discontinuation resulted in no statistically significant difference in BPSD severity change, early study terminations and mortality. However, a statistically significantly higher proportion of subjects with BPSD worsened in this group compared to the continuation group. Further studies are needed to explore the effects of antipsychotic discontinuation on BPSD.

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“…The timescale and extent of this can be likencd to that seen in schizophrenics and in normal volunteers. No definite evidence emerged that PRL levels might be useful as markers of disease severity or response to neuroleptic therapy.KEY woms-Thioridazine, prolactin, dementia.In a previous publication (Findlay et al, 1989) we have reported a study into the behaviour of thioridazine treatment in a population of elderly female inpatients with a diagnosis of senile dementia. Over the period of the study, there were no withdrawal phenomena, and although there was a trend which showed a decline in side-effects for the group in which thioridazine was discontinued, the difference from the group in which treatment was continued was not statistically significant.…”

mentioning

confidence: 98%

“…In a previous publication (Findlay et al, 1989) we have reported a study into the behaviour of thioridazine treatment in a population of elderly female inpatients with a diagnosis of senile dementia. Over the period of the study, there were no withdrawal phenomena, and although there was a trend which showed a decline in side-effects for the group in which thioridazine was discontinued, the difference from the group in which treatment was continued was not statistically significant.…”

mentioning

confidence: 99%

Prolactin response to withdrawal of thioridazine in dementia

Mclennan

Findlay²,

Sharma

et al. 1992

Int J Geriat Psychiatry

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SUMMARYThirty-six female inpatients with a clinical diagnosis of senile dementia of the Alzheimer type were entered into a double-blind withdrawal of their established thioridazine therapy over a four-week period. Prolactin (PRL) levels were assayed at weeks 0, 2 and 4 in both groups. A significant reduction in PRL level over this period was seen in the placebo-substituted group as compared with the active-continued group. Over the same interval there was no significant change or difference between the two groups in terms of cognitive function, behaviour or physical condition. There was no correlation between PRL levels and degree of dementia or dose of thioridazine at the start of the study. This study suggests that the response to thioridazine withdrawal in senile dementia of the Alzheimer type is a reversal of pharmacological hyperprolactinaemia. The timescale and extent of this can be likencd to that seen in schizophrenics and in normal volunteers. No definite evidence emerged that PRL levels might be useful as markers of disease severity or response to neuroleptic therapy.KEY woms-Thioridazine, prolactin, dementia.In a previous publication (Findlay et al., 1989) we have reported a study into the behaviour of thioridazine treatment in a population of elderly female inpatients with a diagnosis of senile dementia. Over the period of the study, there were no withdrawal phenomena, and although there was a trend which showed a decline in side-effects for the group in which thioridazine was discontinued, the difference from the group in which treatment was continued was not statistically significant. This suggested the controlled withdrawal of thioridazine was safe, and should be considered in situations where the value of continued medication was in doubt.Thioridazine, along with other phenothiazines, blocks postsynaptic dopamine (DA) receptors in the tuberoinfundibular system of the hypothalamus and anterior pituitary, thus preventing DA mediated inhibition of PRL release (Meltzer and Fang, 1976;Sachar et al., 1975;Beaumont et al., 1974). Neuroleptics are widely used in the treatment of the major psychoses, and also to control behavioural problems in patients suffering from dementia (Barnes et al., De la Fuente and Rosenbaum, 1981).There have been many studies carried out examining neuroendocrine function in dementia, and

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Double‐blind controlled withdrawal of thioridazine treatment in elderly female inpatients with senile dementia

Cited by 18 publications

References 16 publications

Mental and physical capacity and consumption of neuroleptic drugs in residents of nursing homes

Mental and physical capacity and consumption of neuroleptic drugs in residents of nursing homes

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

Prolactin response to withdrawal of thioridazine in dementia

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