Efficacy and Comparative Effectiveness of Atypical Antipsychotic Medications for Off-Label Uses in Adults

Maher, Alicia Ruelaz; Maglione, Margaret; Bagley, Steven C.; Suttorp, Marika J; Hu, Jianqiang; Ewing, Brett; Wang, Zhen; Timmer, Martha; Sultzer, David L.; Shekelle, Paul G

doi:10.1001/jama.2011.1360

Cited by 507 publications

(415 citation statements)

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“…SGAs have been increasingly prescribed for offlabel conditions such as anxiety, attention deficit hyperactivity disorder (ADHD), insomnia and chemotherapy-induced nausea (Maher et al, 2011;Pringsheim and Gardner, 2014;Devlin and Panagiotopoulos, 2015;Bun et al, 2017;Chelkeba et al, 2017). SGAs, such as olanzapine (OLZ), have numerous metabolic side effects (Newcomer, 2005).…”

Section: Introductionmentioning

confidence: 99%

AICAR Prevents Acute Olanzapine-Induced Disturbances in Glucose Homeostasis

Bush

Townsend

Wright

2018

J Pharmacol Exp Ther

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Section: Introductionmentioning

confidence: 99%

AICAR Prevents Acute Olanzapine-Induced Disturbances in Glucose Homeostasis

Bush

Townsend

Wright

2018

J Pharmacol Exp Ther

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“…Antipsychotic medications have been prescribed for people experiencing BPSD; yet these drugs can have limited efficacy [3][4][5][6] and have been found to be associated with serious adverse events such as stroke and death [5,[7][8][9][10]. Concerned about the risk/benefit ratio, the Department of Health in England acted on a Government-commissioned report [11] and, in 2010, pledged to reduce the use of antipsychotic medications for all people with dementia.…”

Section: Introductionmentioning

confidence: 99%

The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies

2016

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BackgroundAntipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD. AimTo explore the use of non-pharmacological interventions in care homes to manage behavioural and psychological symptoms of dementia. MethodsIn-depth, ethnographic case studies were conducted in 4 care homes; in total they included interviews with 40 care-home staff and 384 hours of participant observations. FindingsNon-pharmacological interventions, some of which are the focus of efficacy research, were used in care homes, but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities. ConclusionsThere is a gap between rhetoric and practice with most non-pharmacological interventions in care homes used as social activities rather than as targeted interventions. If nonpharmacological interventions are to become viable alternatives to antipsychotic medications in care homes further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.2

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“…20,21 The benefit of antipsychotics in the management of BPSD 22,23 and delirium 24 is limited. As such, the use of antipsychotics should be reserved for cases in which nonpharmacological measures have failed and patients pose an imminent threat to themselves or others.…”

Section: Antipsychoticsmentioning

confidence: 99%