Effectiveness of Various Tranquillisers in the Management of Senile Restlessness

Tewfik, G. I.; Jain, Vijay Kumar; Harcup, Mary; Magowan, Samuel

doi:10.1159/000245301

Cited by 17 publications

(5 citation statements)

References 3 publications

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“…Uncontrolled studies of benzodiazepines in elderly psychiatric patients, including some with dementia, have reported generally favorable results, 54–58 but their findings are difficult to apply specifically to dementia patients. In an open study, oxazepam, thioridazine, chlorpromazine, haloperidol, and placebo were compared sequentially in older patients described as having confusion and agitation 59 . Oxazepam (20 to 30 mg per day) showed the most improvement, although thioridazine (100 to 150 mg per day) and chlorpromazine (100 to 150 mg per day) also showed improvement.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Pharmacologic Treatment of Agitation Associated With Dementia

Risse

Barnes

1986

J American Geriatrics Society

120

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Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo-controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long-term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial.

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Section: Benzodiazepinesmentioning

confidence: 99%

Pharmacologic Treatment of Agitation Associated With Dementia

Risse

Barnes

1986

J American Geriatrics Society

120

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“…The few studies that have compared conventional neuroleptics with benzodiazepines suffer from methodologic flaws, particularly in sample selection and study design (Burgio et al, 1992;Covington, 1975;Kirven & Montero, 1973;Stotsky, 1984;Tewfik et al, 1970). The limited data do not indicate superiority for benzodiazepines over neuroleptics in the treatment of behavioral complications in demented patients.…”

Section: Conventional Neuroleptics Versus Benzodiazepinesmentioning

confidence: 99%

Conventional Neuroleptics in Dementia

Devanand

2000

Int. Psychogeriatr.

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“…A multitude of studies, both controlled and uncontrolled, have been done to assess the usefulness of neuroleptics in reducing such behaviours (19)(20)(21)(40)(41)(42)(43)(44)(45). These studies have clearly shown that in some cases neuroleptics can be useful in the treatment of behavioural dyscontrol, hostility, aggression, and perhaps violence in the geriatric population.…”

Section: Agitation Violence and Dyscontrolmentioning

confidence: 99%

Antipsychotics in the elderly

Rosen¹,

Bohon²,

Gershon³

1990

Acta Psychiatr Scand

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Neuroleptics are commonly prescribed medications in the geriatric population and have a broader spectrum of indications than in younger patients. In spite of the frequent use of neuroleptics in elderly patients with organic brain syndromes, there are relatively few studies that use double-blind, placebo-controlled methodology. The results of these studies are conflicting; however, there is sufficient evidence that symptoms of agitation, behaviourial dyscontrol, and psychosis are often responsive to neuroleptic treatment. Elderly patients with schizophrenia or other psychotic disorders may also benefit from neuroleptic treatment. As there is a potential for overuse of these medications among the elderly, clear definition of checklist symptoms is imperative. Furthermore, periodic reduction of dose and possible discontinuation of the drug should be considered since many of the checklist symptoms in this age group are environmentally related and time-limited. There has so far been little evidence to support the use of one neuroleptic over another. Side-effect profiles suggest that low doses of the high potency agents are safer and better tolerated in the elderly. Both therapeutic effects 1 and side effects should be assessed at regular intervals.Neuroleptics are commonly prescribed in the geriatric population (1). It has been estimated that more than 90% of nursing home residents have a significant neuropsychiatric disability, and that perhaps 75% of these patients receive neuroleptics (2).0ther studies similarly suggest that the rates of neuroleptic use among the aged are high regardless of diagnosis. Prien (3) estimated in one nursing home sample that 20% of patients received neuroleptics. Gilleard et al. (4) surveyed the use of neuroleptics amongst patients in various settings. They found that the indications varied from setting to setting, and that disturbed mood or behaviour increased the probability of a patient receiving neuroleptics. Overall, 13% of patients in their sample had received neuroleptics in the 24 hours preceding their survey.The population at risk is enormous and increasing. At present about 11% (25 million) of the population of the USA is over the age of 65 years and current estimates suggest that the prevalence of dementia in those over that age is about 4% ( 5 ) and the incidence increases with age (6). Whereas about one million Americans are severely demented, it is estimated that by the year 2000, an additional 300,000 will be so affected (5). Over 75% of patients with dementia have disruptive behaviour or psychotic symptoms (7,8). With such a large population at risk, it is essential that the clinician be well-versed in the use of neuroleptics, and be aware of treatable symptoms.

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Effectiveness of Various Tranquillisers in the Management of Senile Restlessness

Cited by 17 publications

References 3 publications

Pharmacologic Treatment of Agitation Associated With Dementia

Pharmacologic Treatment of Agitation Associated With Dementia

Conventional Neuroleptics in Dementia

Antipsychotics in the elderly

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