Tardive dyskinesias in the elderly

Fabbrini, Giovanni; Barbanti, Piero; Aurilia, Cinzia

doi:10.1002/1099-1166(200112)16:1+<::aid-gps563>3.0.co;2-0

Cited by 7 publications

(3 citation statements)

References 31 publications

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“…Compared with typical antipsychotic agents, atypical antipsychotics are thought to be less likely to cause extrapyramidal symptoms such as parkinsonism and tardive dyskinesia 10 – 12. Data supporting the efficacy and safety of atypical antipsychotics need to be examined, especially in light of their high costs and newly identified adverse events.…”

Section: Introductionmentioning

confidence: 99%

Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review

Lee

Gill

Freedman

et al. 2004

BMJ

204

112

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Objective To review the role of oral atypical antipsychotic drugs in the management of the behavioural and psychological symptoms of dementia (BPSD). Data sources Medline, Embase, and the Cochrane Library. Reference lists were reviewed and experts were contacted to identify additional trials. Study selection Double blind randomised controlled trials that evaluated the four oral atypical antipsychotic therapies for BPSD. Review methods Two reviewers assessed trial validity independently. Data extraction Demographics of patients, study duration, dose of antipsychotic, primary end points, adverse events. Results 77 abstracts were reviewed. Five randomised trials (1570 patients) evaluating risperidone and olanzapine were identified. The quality of trials was generally good. Most participants were in an institution ( > 96%), elderly (weighted mean 82.3 years), and had Alzheimer's disease (76.3%). Trials lasted 6-12 weeks. Treatment with atypical antipsychotic drugs was superior to placebo for the primary end point in three of the five trials. Two trials comparing risperidone with haloperidol did not find any differences in the primary measures of efficacy. Adverse events were common and included extrapyramidal symptoms, somnolence, and abnormal gait. Conclusions Although atypical antipsychotic drugs are being used with increasing frequency, few randomised trials have evaluated their use for BPSD. Limited evidence supports the perception of improved efficacy and adverse event profiles compared with typical antipsychotic drugs.

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Section: Introductionmentioning

confidence: 99%

Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review

Lee

Gill

Freedman

et al. 2004

BMJ

204

112

View full text Add to dashboard Cite

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“…24 The risk of many adverse events (including tardive dyskinesia) also increases with age. 25 Atypical antipsychotics are often thought to have a lower risk of extrapyramidal side effects and movement disorders such as tardive dyskinesia, 26 although some researchers argue that older adults treated with atypicals are also at risk for these complications. 27 The incidence of comorbid conditions that can affect outcomes and responses to treatment is also greater in the elderly population.…”

Section: Helpful [Editor's Note: a "Guide For Families And Caregivermentioning

confidence: 99%

Managing Risk When Considering the Use of Atypical Antipsychotics for Elderly Patients with Dementia-Related Psychosis

Recupero

Rainey²

2007

Journal of Psychiatric Practice

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In 2005, responding to several studies, the FDA issued a black box warning on atypical (second generation) antipsychotic medications, noting that the drugs may increase the risk of cerebrovascular adverse events in elderly patients with dementia-related behavior disturbances. The black box warning has raised concern for clinicians, among whom atypical antipsychotics have gained favor for having a more tolerable side-effect profile than many other pharmacological treatment options. Complicating this concern are studies suggesting that other medications may have similar risks and a dearth of unbiased head-to-head studies comparing different treatment options. To effectively manage risk when treating elderly patients with dementia-related psychosis, physicians, patients, and caregivers must consider both acute risks (such as danger of bodily harm to the patient and others) and long-term risks (such as placement in a restrictive nursing home). If an atypical antipsychotic is chosen, additional risk management may be warranted. This paper presents a brief overview of relevant concerns and suggests some techniques to help minimize and manage risk, such as increased monitoring, informed consent, and thorough documentation. A sample clinical risk management form and a sample letter to the primary care physician are provided to help guide clinicians in improving their risk management practices when working with elderly patients suffering from dementia-related psychosis and related behavioral difficulties.

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“…Jahr der Anwendung des Olanzapin manifestierte. Es kann jedoch angenommen werden, dass aufgrund des Alters des Patienten das Auftreten einer tardi− ven Dyskinesie insgesamt wahrscheinlicher geworden ist [7]. Andere Risikofaktoren der Genese einer tardiven Dyskinesie (Anwendung konventioneller Neuroleptika, affektive Begleitstö− rung, hirnmorphologische Störungen) lagen bei dem Patienten nicht vor.…”

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