Haloperidol and sudden cardiac death in dementia: autopsy findings in psychiatric inpatients

Ifteni, Petru; Grudnikoff, Eugene; Koppel, Jeremy; Kremen, Neil; Correll, Christoph U.; Kane, John M.; Manu, Peter

doi:10.1002/gps.4277

Cited by 10 publications

(4 citation statements)

References 32 publications

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“…In dementia psychotic symptoms are frequent and occur mostly in the moderate phase. Halucinations and delusions are the componenets of the chalenging behaioour and requaring admission and treatment with antipsychotics and institutionalization [15,16].…”

Section: Resultsmentioning

confidence: 99%

Acetylcholinesterase Inhibitors Test Confirmed Myasthenia Gravis in Psychosis Remitted by Aripiprazole

Teodorescu¹,

Ifteni²,

Petric³

et al. 2018

Rev. Chim.

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Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease affecting the neuromuscular junction and causes weakness in the skeletal muscles. The acetylcholine receptor is usually attacked in skeletal muscles, but other components of neuromuscular junction, such as muscle-specific receptor tyrosine kinase, may be affected. MG can be life-threatening when the respiratory muscles are involved. The first symptom in about 2 out of 3 cases is the damage of the extrinsic eye muscles. The condition is treatable, so an early recognition is needed. Although there have been reports of associations between psychosis and myasthenia gravis it is unclear if psychotic symptoms in MG are an integral part of the various manifestations of this disease, or are due to another co-occurring distinct disorder. Sometimes psychotic episodes could disguise the simptoms of myastenia gravis, and delay the diagnosis.

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Section: Resultsmentioning

confidence: 99%

Acetylcholinesterase Inhibitors Test Confirmed Myasthenia Gravis in Psychosis Remitted by Aripiprazole

Teodorescu¹,

Ifteni²,

Petric³

et al. 2018

Rev. Chim.

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“…The low toxicity of haloperidol makes it less of a priority in psychiatric treatment research than other psychomimetic drugs because it is rarely linked to sudden deaths in conditions such as dementia [35].…”

Section: Discussionmentioning

confidence: 99%

Zebrafish as a model for haloperidol-induced catalepsy-like immobilization

Hasumi¹,

Maeda²,

Yoshida³

2021

Preprint

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This study investigated the validity of screening for antipsychotic-induced catalepsy-like immobilization in zebrafish (Danio rerio), as an alternative to the standard rodent model. To induce the desired symptoms, we used haloperidol, a typical antipsychotic that disturbs dopamine D2-receptors. In addition to observing swimming behaviors generally, we used the light and dark test to assess how drug exposure influences locomotive responses to those stimuli. We selected this test instead of the commonly used bar test for catalepsy in rodents, because fish cannot perform the necessary motions to participate in the latter. Normally, light attenuated activity and decreased locomotion, whereas darkness greatly increased activity levels in zebrafish. We confirmed that haloperidol had a dose-dependent inhibitory effect on activity; the highest dose of 10 mg/L almost stopped fish activity even in darkness. We did not observe any significant differences in heart rate or morphology across the control and treatment groups, whereas abnormal movements like rigid and erratic behaviors occurred in haloperidol-treated groups. Therefore, we found that immobilization and abnormal movements qualify as haloperidol-induced catalepsy. In conclusion, zebrafish appear to be a suitable model for antipsychotic-induced catalepsy-like immobilization.

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“…A review of major cardiac adverse events associated with antipsychotic agents found no clinically significant difference between conventional and atypical agents . In 1 study, autopsy data also suggested that haloperidol is not associated with sudden death in dementia patients . However, 1 retrospective study found a greater relative risk associated with conventional antipsychotics, as did 3 reviews of observational studies .…”

Section: Adverse Events and Excess Mortality Associated With Antipsycmentioning

confidence: 99%

“…68 In 1 study, autopsy data also suggested that haloperidol is not associated with sudden death in dementia patients. 69 However, 1 retrospective study found a greater relative risk associated with conventional antipsychotics, 70 as did 3 reviews of observational studies. 64,66,71 One of these found that hip fracture, stroke, myocardial infarction, and ventricular arrhythmia are among the factors that explain the mortality difference between conventional and atypical agents.…”

Section: Adverse Events and Excess Mortality Associated With Antipsycmentioning

confidence: 99%

Use of Antipsychotics for the Treatment of Behavioral Symptoms of Dementia

Greenblatt

2016

The Journal of Clinical Pharma

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Antipsychotic medications are widely used in the management of behavioral and psychological symptoms of dementia. While nonpharmacological interventions should be the first-line treatment for behavioral symptoms of dementia, these are often unfeasible and/or ineffective. Conventional and atypical antipsychotic agents appear to have modest to moderate clinical efficacy in the treatment of these symptoms, though it is unclear which individual agents are most effective. No conclusive evidence exists that any available alternative medications are safer and more effective than antipsychotics. A number of studies have shown an increased risk of mortality associated with antipsychotics in patients with behavioral symptoms of dementia, though the observed risk increase may be partially confounded by illness severity and/or preexisting health determinants. The mechanisms of increased mortality risk are not fully established, but are likely to involve cardiovascular events. It is probable, though not certain, that conventional antipsychotics are associated with a greater number of poor outcomes than atypical antipsychotics. In certain patients with refractory behavioral symptoms, antipsychotics are a viable treatment option. Key considerations for antipsychotic prescribing for this population are published in regulatory guidelines, and include minimization of dosage and duration of treatment, continuous reevaluation of symptoms, and involvement of caregivers.

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Haloperidol and sudden cardiac death in dementia: autopsy findings in psychiatric inpatients

Abstract: Autopsy data suggest that oral haloperidol is not associated with increased risk of sudden cardiac death in psychiatric inpatients with dementia.

Cited by 10 publications

References 32 publications

Acetylcholinesterase Inhibitors Test Confirmed Myasthenia Gravis in Psychosis Remitted by Aripiprazole

Acetylcholinesterase Inhibitors Test Confirmed Myasthenia Gravis in Psychosis Remitted by Aripiprazole

Zebrafish as a model for haloperidol-induced catalepsy-like immobilization

Use of Antipsychotics for the Treatment of Behavioral Symptoms of Dementia

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