Clinical Symptom Responses to Atypical Antipsychotic Medications in Alzheimer’s Disease: Phase 1 Outcomes From the CATIE-AD Effectiveness Trial

Sultzer, David L.; Davis, Sonia M.; Tariot, Pierre N.; Dagerman, Karen; Lebowitz, Barry D.; Lyketsos, Constantine G.; Rosenheck, Robert A.; Hsiao, John K.; Lieberman, Jeffrey A.; Schneider, Lon S.

doi:10.1176/appi.ajp.2008.07111779

Cited by 282 publications

(191 citation statements)

References 39 publications

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“…Time-to-discontinuation studies (CATIE-AD) showing problems in tolerability further questioned the use of atypical antipsychotics in this patient group (284), although positive effects were seen in some symptom domains, such as anger, aggression, and paranoid ideas. However, this did not reduce care needs or improve the quality of life (310). Psychotropic medication should be used for BPSD only if nonpharmacological measures are ineffective (279).…”

Section: Antipsychotic Therapy Of DImentioning

confidence: 99%

Delusional Infestation

Freudenmann

Lepping²

2009

Clin Microbiol Rev

230

367

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SUMMARY This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis. It is characterized by the fixed belief of being infested with pathogens against all medical evidence. DI is no single disorder but can occur as a delusional disorder of the somatic type (primary DI) or secondary to numerous other conditions. A set of minimal diagnostic criteria and a classification are provided. Patients with DI pose a truly interdisciplinary problem to the medical system. They avoid psychiatrists and consult dermatologists, microbiologists, or general practitioners but often lose faith in professional medicine. Epidemiology and history suggest that the imaginary pathogens change constantly, while the delusional theme “infestation” is stable and ubiquitous. Patients with self-diagnosed “Morgellons disease” can be seen as a variation of this delusional theme. For clinicians, clinical pathways for efficient diagnostics and etiology-specific treatment are provided. Specialized outpatient clinics in dermatology with a liaison psychiatrist are theoretically best placed to provide care. The most intricate problem is to engage patients in psychiatric therapy. In primary DI, antipsychotics are the treatment of choice, according to limited but sufficient evidence. Pimozide is no longer the treatment of choice for reasons of drug safety. Future research should focus on pathophysiology and the neural basis of DI, as well as on conclusive clinical trials, which are widely lacking. Innovative approaches will be needed, since otherwise patients are unlikely to adhere to any study protocol.

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Section: Antipsychotic Therapy Of DImentioning

confidence: 99%

Delusional Infestation

Freudenmann

Lepping²

2009

Clin Microbiol Rev

230

367

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“…4 The BPRS assesses 24 symptoms covering a range of affective, psychotic, and behavioural disturbances. The instrument can be administered in 10 minutes.…”

Section: Brief Psychiatric Rating Scalementioning

confidence: 99%

Psychiatric assessment of patients with dementia in the community

Jethwa

2015

Br J Gen Pract

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Physical decline and behavioural disturbance in advancing dementia often precipitates hospital or nursing home admission.1 The coexistence of behavioural or psychological symptoms and physical illness requires timely input from a number of professionals in both the health and social services.Numerous rating scales are available to assess different aspects of dementia, including cognition, psychopathology, quality-of-life, and caregiver burden.

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“…The Clinical Antipsychotic Trials of Intervention EffectivenessAlzheimer Disease study (CATIE-AD) showed benefits of risperidone and olanzapine on the NPI total score. However, there was high rate of discontinuation due to adverse effects [27] . Quetiapine was shown to have limited efficacy on symptoms which may have been related to the low doses prescribed.…”

Section: Sedative-hypnoticsmentioning

confidence: 99%

Pharmacological management of behavioral symptoms associated with dementia

Madhusoodanan

Ting

2014

WJP

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Core tip: Dementia may present with neuropsychiatric symptoms that may require pharmacological interventions. Medications used for the behavioral symptoms associ ated with dementia are not Food and Drug Administration approved and hence are being used offlabel in the United States. The decision to start medications is based on a judi cious consideration of risks and benefits. The choice of the agent should be guided by a thorough understanding of its pharmacologic properties and safety profiles, concomitant medications, and concurrent medical conditions. This article reviews the current evidence for psychotropic medications and presents recommendations with an algorithm for the treatment of neuropsychiatric symptoms associated with dementia. INTRODUCTIONDementia is a clinical syndrome which includes a heterogeneous group of disorders that lead to cognitive decline in the absence of delirium [1] . Although the cognitive decline is a core feature of dementia, this may be associated with a variety of neuropsychiatric symptoms [1] . These symptoms are as follows: (1) affective and motivational symptoms; (2) perceptual disturbances; (3) delusions; (4) disturbances of basic drives; and (5) disinhibition and inappropriate behaviors [1] . A five-year study on the AbstractDementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type. Dementia is associated with a variety of neuropsychiatric symptoms that may include agitation, psychosis, depression, and apathy. These symptoms can lead to dangerousness to self or others and are the main source for caregiver burnout. Treatment of these symptoms consists of nonpharmacological and pharmacological interventions. However, there are no Food and Drug Administrationapproved medications for the treatment of behavioral and psychological symptoms of dementia. Pharmacological interventions are used offlabel. This article reviews the current evidence supporting or negating the use of psychotropic medications along with safety concerns, monitoring, regulations, and recommendations. REVIEWSubmit a

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Clinical Symptom Responses to Atypical Antipsychotic Medications in Alzheimer’s Disease: Phase 1 Outcomes From the CATIE-AD Effectiveness Trial

Cited by 282 publications

References 39 publications

Delusional Infestation

Delusional Infestation

Psychiatric assessment of patients with dementia in the community

Pharmacological management of behavioral symptoms associated with dementia

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