Comparison of Risperidone and Placebo for Psychosis and Behavioral Disturbances Associated With Dementia

Katz, Ira R.; Jeste, Dilip V.; Mintzer, Jacobo; Clyde, Christopher; Napolitano, Jason; Brecher, Martin

doi:10.4088/jcp.v60n0207

Cited by 681 publications

(535 citation statements)

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“…'Combining data from all the 3 published large-scale double-blind placebo-controlled trials of risperidone, (De Deyn et al, 1999;Katz et al, 1999; 12 out of 744 patients on risperidone compared to 4 out of 562 on placebo developed serious cerebrovascular events. Of these patients, 4 on risperidone and 2 on placebo died.…”

Section: Cerebrovascular Adverse Eventsmentioning

confidence: 99%

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

318

273

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In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly people with dementia, determined that atypical antipsychotics were associated with a significantly (1.6-1.7 times) greater mortality risk compared with placebo, and asked that drug manufacturers add a 'black box' warning to prescribing information for these drugs. Most deaths were due to either cardiac or infectious causes, the two most common immediate causes of death in dementia in general. Clinicians, patients, and caregivers are left with unclear choices of treatment for dementia patients with psychosis and/or severe agitation. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there is a paucity of evidence-based treatment alternatives to antipsychotics for this population. Thus, there is insufficient evidence to suggest that psychotropics other than antipsychotics represent an overall effective and safe, let alone better, treatment choice for psychosis or agitation in dementia; currently no such treatment has been approved by the FDA for these symptoms. Similarly, the data on the efficacy of specific psychosocial treatments in patients with dementia are limited and inconclusive. The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/ or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.

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Section: Cerebrovascular Adverse Eventsmentioning

confidence: 99%

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Jeste

Blazer

Casey

et al. 2007

Neuropsychopharmacol

318

273

View full text Add to dashboard Cite

show abstract

“…Risperidone has been the most widely researched, with consistent results (Bhana & Spencer, 2000). Katz et al's randomised controlled trial of 625 patients found that risperidone (1mg daily) reduced psychosis, paranoid/delusional ideation and aggression in 60%, with a relative lack of side-effects (Katz et al, 1999). Likewise, olanzapine has been shown to improve psychosis and agitation in severe dementia (Street et al, 2000), the main side-effects being sedation and gait disturbance.…”

Section: Discussionmentioning

confidence: 97%

Prescribing patterns for psychotic and behavioural symptoms in dementia: a national survey

Scott¹,

Lawrence²,

Duggal³

et al. 2002

Psychiatr. bull.

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Aims and MethodTo compare current prescribing practice for psychotic and behavioural symptoms in dementia with the available research. An anonymous questionnaire was sent to all members of the Faculty of Old Age Psychiatry, enquiring about preferred drug treatments.ResultsClassical antipsychotics were chosen by 50% for psychotic symptoms over atypical antipsychotics (43%) and were preferred for aggression (48%) and sexual disinhibition (55%). Antidepressants were favoured in treating anxiety (41%) and lability (45%).Clinical ImplicationsAlternatives to classical antipsychotics, especially for behavioural symptoms, have yet to be researched satisfactorily. In view of the continued widespread use of classical antipsychotics and recent concerns about their safety, we call for this to be addressed.

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“…Moreover, a commonly drawn conclusion after literature review is that risperidone-associated angioedema occurs in a dose-dependent fashion [8]. In most reported cases, the adverse effect occurs increasing the dose of risperidone, and resolves with decreasing or discontinuing the medication.…”

Section: Discussionmentioning

confidence: 99%

“…The doses with the reported adverse effect started from as low as 1 mg/day to as high as 10 mg/day [9]. Furthermore, Katz et al reported a dose-dependent increase in peripheral angioedema in a large group of elderly patients [8]. In patients who received 0.5 mg/day of risperidone, peripheral angioedema occurred at a rate of 16.1% whereas an increase to 2 mg/day increased the rate to 18.1%.…”

Section: Discussionmentioning

confidence: 99%

Risperidone induced angioedema with concurrent EPS symptoms: a case report and review of literature

Samra

Kant

Chow

2018

Journal of Community Hospital Internal Medicine Perspectives

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Angioedema has recently been reported as a side effect associated with the antipsychotic risperidone. We report a case of dystonia with concurrent angioedema due to risperidone. A 40-year-old male with a history of schizophrenia was started on 3 mg of risperidone BID and developed perioral and periorbital edema along with increased muscle rigidity and hand tremor within 24 h of initial administration. His symptoms abated after cessation of risperidone and intravenous administration of corticosteroids and antihistamine. This case study adds to the current literature, which has already established angioedema as a dose-dependent side effect of risperidone. Moreover, this case study aims to increase awareness about the potential for the simultaneous occurrence of angioedema and extrapyramidal symptoms, and promotes vigilance among prescribers so that the life-threatening consequences of such effects can be avoided.

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Comparison of Risperidone and Placebo for Psychosis and Behavioral Disturbances Associated With Dementia

Cited by 681 publications

References 0 publications

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

Prescribing patterns for psychotic and behavioural symptoms in dementia: a national survey

Risperidone induced angioedema with concurrent EPS symptoms: a case report and review of literature

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