Comparison of Citalopram, Perphenazine, and Placebo for the Acute Treatment of Psychosis and Behavioral Disturbances in Hospitalized, Demented Patients

Pollock, Bruce G.; Mulsant, Benoit H.; Rosen, Jules; Sweet, Robert A.; Mazumdar, Sati; Bharucha, Ashok J.; Marin, Robert S.; Jacob, N.; Huber, Kimberly; Kastango, Kari B.; Chew, Marci L.

doi:10.1176/appi.ajp.159.3.460

Cited by 294 publications

(180 citation statements)

References 29 publications

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“…Citalopram was reported to be effective in reducing all kinds of NPS in a study of 98 patients (Nyth and Gottfries, 1990). In a DB RCT study of 85 patients treated with citalopram, perphenazine or a placebo for up to 17 days, citalopram was found to be superior to a placebo in treating psychosis and behavioural symptoms (Pollock et al, 2002). Nevertheless, four other studies reported that antidepressants were not more effective than a placebo for NPS (Auchus and Bissey-Black, 1997;Teri et al, 2000;Lyketsos et al, 2003;Finkel et al, 2004), and a review concluded that antidepressants were not very effective in the treatment of NPS (Seitz et al, 2011).…”

Section: Antidepressive Medicationmentioning

confidence: 98%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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ObjectiveThe Severe Impairment Battery (SIB) is developed to test cognitive function in patients with dementia of moderate to severe degree. We have conducted a study to assess the inter‐rater reliability and the validity of the Norwegian version of SIB.MethodsThe reliability study comprised 30 patients, and the validity study 59 patients in nursing homes. We assessed Cronbach's alpha coefficient of the scale and the inter‐rater reliability for the total SIB score and its nine sub scores between two testers by means of the Spearman's correlation coefficients. In the validity study we compared the SIB scores with the scores on the Clinical Dementia Rating Scale.ResultsThe mean SIB score was 72.10 (SD 25.37). The Cronbach's alpha was 0.97, and the inter‐rater reliability of total SIB score was Spearman's rho 0.85, and ranged from 0.46 to 0.76 for the nine sub‐scores. The mean SIB score for patients with a CDR score < 2 was 84.2(13.4), whereas total scores for patients with CDR 2 and 3 were 74 (18.9) and 48.4 (33.3), respectively. A cut‐off point of 80.5 points gave the highest accuracy in discriminating between patients with CDR 2 and CDR 3, while a cut‐off point of 87.5 best discriminated between CDR < 2 and CDR 3.ConclusionThe study indicates that the Norwegian version of SIB is a reliable and valid test with which to evaluate the cognition in patients with dementia of moderate to severe degree. Copyright © 2008 John Wiley & Sons, Ltd.

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Section: Antidepressive Medicationmentioning

confidence: 98%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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“…16 Selective serotonin reuptake inhibitors seem to have efficacy for treatment of agitation in patients with AD. Studies have demonstrated benefits for agitation with citalopram compared with placebo 76 and similar efficacy compared with risperidone. 77 …”

Section: Tricyclic Antidepressant Agentsmentioning

confidence: 99%

Guidelines for the Management of Cognitive and Behavioral Problems in Dementia

Sadowsky¹,

Galvin²

2012

The Journal of the American Board of Family Medicine

115

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Family physicians play a crucial role in the management and ongoing care of patients with Alzheimer disease (AD). This article reviews the effects of nonpharmacologic and pharmacologic interventions on the functional abilities and behavior of patients with dementia and how these can be implemented into clinical practice. Nonpharmacologic interventions are recommended as the initial strategy for managing problematic behaviors. Strategies for improving behavior include ensuring that the patient's environment is safe, calm, and predictable; removing environmental stressors; and identifying and avoiding situations that agitate or frighten the patient. Simple interventions include redirecting and refocusing the patient, increasing social interaction, establishing regular sleep habits, eliminating sources of conflict and frustration, and establishing rewards for successes. The effectiveness of long-term behavioral management is largely dependent on the caregiver; as such, it is important to assess the role and needs of the caregiver.Because currently available therapies cannot reverse the pathologic processes of AD, the primary objective of pharmacotherapy is to preserve cognitive and functional ability, minimize behavioral disturbances, and slow disease progression. Cholinesterase inhibitors represent first-line therapy for patients with mild to moderate AD, whereas a glutamate N-methyl D-aspartate antagonist is used in the treatment of moderate to severe AD. Looking forward, there are a number of therapies in development aimed at modifying the disease course; these include amyloid-lowering drugs, -based and neuroprotective approaches, acetylcholine agonists, and mitochondrial inhibitors.

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“…The etiology of behavioral and psychological symptoms in dementia is not the same as in schizophrenia, and a serotonin deficit is thought to be important (Herrmann and Lanctôt, 1997). Treatment with serotonin receptor antagonists (like the atypical antipsychotics) seems irrational from that point of view, and serotonin-specific reuptake inhibitors (SSRIs) have also been shown to have a better effect on aggressive behavior than antipsychotic agents (Pollock et al, 2002). There is still a need for randomized studies comparing the efficacy of different classes of psychotropics in the treatment of behavioral disturbances (e.g.…”

Section: A N T I P S Y C H O T I C S a N T I P S Y C H O T I C S N Omentioning

confidence: 99%

Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care

Lövheim

Sandman

Kallin

et al. 2006

Int. Psychogeriatr.

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Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care.. International psychogeriatrics, ABSTRACTBackground: Behavioral and psychological symptoms of dementia (BPSD) commonly occur among cognitively impaired people in geriatric care. BPSD are often managed with antipsychotic drugs, despite the associated serious health risks. The aim of the present study was to discover factors associated with the use of antipsychotics.

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Comparison of Citalopram, Perphenazine, and Placebo for the Acute Treatment of Psychosis and Behavioral Disturbances in Hospitalized, Demented Patients

Abstract: Citalopram was found to be more efficacious than placebo in the short-term hospital treatment of psychotic symptoms and behavioral disturbances in nondepressed, demented patients.

Cited by 294 publications

References 29 publications

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Guidelines for the Management of Cognitive and Behavioral Problems in Dementia

Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care

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