Treating Psychotic Symptoms in Elderly Patients

Targum, Steven D.

doi:10.4088/pcc.v03n0402

Cited by 37 publications

(21 citation statements)

References 49 publications

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“…Bassiony and colleagues [47] reported significant independent associations between anxiolytics and antihypertensives treatment and late-life psychosis. Whereas association between multiple medications use and late-life psychosis has been described in clinical commentaries [34], the present study is to our knowledge the first research to empirically show the association between polypharmacy and psychosis in late life. Future studies employing longitudinal designs should examine the extent to which multiple medications are causal to psychosis or may result from attempts to control the psychosis.…”

Section: Discussionmentioning

confidence: 75%

An Initial Study of Modifiable and Non-Modifiable Factors for Late-Life Psychosis

Onwuameze

Schultz

Paradiso

2011

Int J Psychiatry Med

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Objective To determine rates of psychotic symptoms and associated modifiable and non-modifiable factors among elderly long term nursing home residents without prior history of psychiatric illness. Method A cross-sectional design using the Scale for the Assessment of Positive Symptoms (SAPS) to measure psychotic symptoms, the Folstein’s Mini-Mental State Exam (MMSE), and Mattis Dementia Rating Scale (DRS) to evaluate cognitive impairment. Frequency and rates of global psychotic symptoms and hallucinations, delusions, formal thought disorder, and bizarre behavior were calculated. Logistic regression was used to examine modifiable (e.g., medication use) and non-modifiable clinical characteristics (e.g., older age) associated with late-life psychosis. Results There were 15.9% of subjects reporting delusions and 7.3% reporting hallucinations. History of stroke, poorer cognition, and receiving multiple medications showed significant association with late-life psychosis. Only stroke (OR = 9.12; 95% CI: 1.58-52.74) and receiving different classes of medications (benzodiazepines, neuroleptics, and antidepressants) (OR = 13.17; 95% CI: 2.10-85.82) remained significantly associated with psychosis after adjusting for Mattis DRS total score. Further analyses excluding subjects with MMSE scores of 24 or lower (n = 24) showed essentially the same results but subjects with better cognitive function suffered a less severe form of psychosis, essentially constituted by one symptom type (i.e., visual hallucinations). Conclusions Rates of late-life psychosis in this sample of nursing home residents without previous psychiatric history were high. Simultaneous use of medications including antidepressants, sedatives, and stimulants may be a clinically relevant modifiable factor to be targeted in prevention studies. Severity and type of psychosis is dependent on the severity of cognitive impairment.

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Section: Discussionmentioning

confidence: 75%

An Initial Study of Modifiable and Non-Modifiable Factors for Late-Life Psychosis

Onwuameze

Schultz

Paradiso

2011

Int J Psychiatry Med

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“…Notably, acute infection (eg, pneumonia) might lead to substantial short-term increased risk of neuropsychiatric events. 38 Because H pylori is by nature a chronic infection, it is unlikely to temporally change the incidence of neuropsychiatric events shortly before and after treatment initiation. Therefore, it is less likely to lead to a spurious short-term association between therapy and outcome.…”

Section: Discussionmentioning

confidence: 99%

Association Between Acute Neuropsychiatric Events andHelicobacter pyloriTherapy Containing Clarithromycin

Wong

Chui

et al. 2016

JAMA Intern Med

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IMPORTANCE There is a concern that Helicobacter pylori therapy containing clarithromycin might be associated with acute neuropsychiatric events. OBJECTIVE To examine the association between H pylori therapy containing clarithromycin and acute neuropsychiatric events. DESIGN, SETTING, AND PARTICIPANTS A self-controlled case series study was conducted using the Clinical Data Analysis and Reporting System database in Hong Kong to explore any association. The exposure of interest was H pylori therapy containing clarithromycin in the outpatient setting. Study patients, 18 years or older at cohort entry, must have had both exposure to H pylori therapy containing clarithromycin and their first recorded neuropsychiatric events between January 1, 2003, and December 31, 2012. A post hoc nested case-control analysis was also performed in patients receiving H pylori therapy containing clarithromycin. MAIN OUTCOMES AND MEASURES The primary outcome was composite neuropsychiatric events, while secondary outcomes were psychotic events and cognitive impairment. Risk periods in the self-controlled case series analysis were defined as 14-day preexposure period, current use (days 1-14 since prescription start date) and recent use (days 15-30). Age-adjusted incidence rate ratios (IRR) were estimated using the conditional Poisson regression. RESULTS Of 66 559 patients who had at least 1 outpatient prescription of H pylori therapy containing clarithromycin. Their mean (SD) age at cohort entry was 50.8 (14.8 years); their mean age at first exposure was 55.4 (14.8) years, and 30 910 were male (46.4%). A total of 1824 patients had their first recorded composite neuropsychiatric events during the study period. An increased IRR of 4.12 (35 composite neuropsychiatric events during 72 person-years; 95% CI, 2.94-5.76) during current use was observed but not in recent use (9 events during 82 person-years; IRR, 0.95; 95% CI, 0.49-1.83) and 14-day preexposure period (14 events during 72 person-years; IRR, 1.63; 95% CI, 0.96-2.77) vs baseline (1766 events during 16 665 person-years). Similarly, both the risk of psychotic events and cognitive impairment increased during current use vs baseline, although this subsequently returned to baseline incidence levels during recent use. The crude absolute risks of composite neuropsychiatric events, psychotic events, and cognitive impairment during current use were 0.45, 0.12, and 0.12 per 1000 prescriptions, respectively. The nested case-control analysis also gave similar results to that of the self-controlled case series analysis. CONCLUSIONS AND RELEVANCE This study shows evidence of a short-term increased risk of neuropsychiatric events associated with H pylori therapy containing clarithromycin.

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“…4 Some authors have suggested that electrolyte abnormalities may cause mood swings. These patients may exhibit cognitive, perceptual, emotional, and behavioral disturbances including confusion, impaired attention and memory skills, hallucinations, delusions, disorganized speech, agitation, aggressiveness, labile mood, and altered sleep-wake pattern.…”

Section: Discussionmentioning

confidence: 99%