Withdrawal of Haloperidol, Thioridazine, and Lorazepam in the Nursing Home

Cohen‐Mansfield, Jiska; Lipson, Stephen J.; Werner, Perla; Billig, Nathan; Taylor, Lauren A.; Woosley, Raymond L.

doi:10.1001/archinte.159.15.1733

Cited by 106 publications

(59 citation statements)

References 27 publications

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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%

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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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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“…[23][24][25] Such interventions have been found to be well tolerated and to not result in increased behavioral disturbances. Although current regulations in the nursing home setting require discontinuation trials, there are no such similarly strong policy-level recommendations in the non-nursing home setting.…”

Section: Discussionmentioning

confidence: 99%

Documentation of Antipsychotic Use and Indications for Newly Diagnosed, Nonaggressive Dementia Patients

Dhawan¹,

Morgan²,

Snow³

et al. 2008

Prim. Care Companion J. Clin. Psychiatry

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PSYCHIATRIST.COM percent of patients with dementia display behavioral and psychological symptoms, such as agitation, wandering, depression, and anxiety. These symptoms increase the cost of care, caregiver burden, and risk of nursing home placement, and decrease patient quality of life.2-4 To care for dementia patients, clinicians must give as much if not more attention to managing associated behavioral problems as they do to attempting to slow the progression of cognitive decline.Guidelines suggest that nonpharmacologic treatment, such as modification of daily activities or sensory therapy, should be first-line treatment for any behavioral and psychological symptom of dementia (BPSD).5-8 However, in practice there has been low adherence to using nonpharmacologic treatment.9 A reported 27% of dementia outpatients are taking antipsychotics, 10 while one multicenter study found 32.4% antipsychotic use in nursing home Objective: The purpose of this study was to determine the prevalence of antipsychotic use among nonaggressive patients with newly diagnosed dementia and to examine indications for antipsychotic use.Method: Patients had to be veterans older than 60 years, newly diagnosed with dementia (ICD-9-CM criteria) from 2001 to 2004 at the Michael A. DeBakey Veterans Affairs Medical Center in Houston, Tex. Patients diagnosed more than 1 year before telephone screening, living in a nursing home or having a caregiver less than 8 hours a week, and/or having aggression, determined by caregiver response on the Ryden Aggression Scale, were excluded. Medical records of eligible participants were then evaluated on the basis of 5 questions: (1) Was the patient taking an antipsychotic? (2) Were neuropsychiatric symptoms documented, with or without antipsychotics? (3) Did the patient have comorbid psychiatric diagnoses? (4) Did the physician attempt to decrease or discontinue the antipsychotic? and (5) Did the physician attempt nonpharmacologic interventions?Results: A total of 173 patients were eligible for medical record evaluation. Of these, 29 (17%) had been prescribed antipsychotics. Depression, nighttime disturbance, and irritability were the most often documented neuropsychiatric symptoms; however, 31% of patients had no documented symptoms. Mood disorder was documented in 36% of patient records; however, 94 patients (54%) had no comorbid psychiatric disorder. Twelve nonpharmacologic interventions were documented for dementia symptoms. Only 2 attempts to discontinue or decrease antipsychotics for the 29 patients using them were documented.Conclusion: A sizable minority of newly diagnosed, nonaggressive dementia patients are taking antipsychotics. Physicians need greater education and awareness of the benefits of nonpharmacologic interventions.(Prim Care Companion J Clin Psychiatry 2008;10:97-102) O

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“…Haloperidol is frequently used in doses varying from 0.25 mg to 3 mg. Withdrawal of haloperidol, thioridazine, and lorazepam in one study in nursing home patients with controlled crossover to placebo found no behavioral or functional differences between drugs. 129 A recent study 130 found no difference between patients who received haloperidol, trazodone, behavioral intervention, or placebo for agitation in patients with probable Alzheimer's disease. Conventional neuroleptics in the elderly are associated with a very high incidence of serious adverse events such as EPS, tardive dyskinesia, falls and fractures, orthostasis, and anticholinergic effects.…”

Section: Conventional Antipsychoticsmentioning

confidence: 99%