The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia

Reus, Victor I.; Fochtmann, Laura J.; Eyler, A. Evan; Hilty, Donald M.; Horvitz-Lennon, Marcela; Jibson, Michael D.; López, Oscar L.; Mahoney, Jane; Pasic, Jagoda; Tan, Zaldy S.; Wills, Cheryl D.; Rhoads, Richard S.; Yager, Joel

doi:10.1176/appi.ajp.2015.173501

Cited by 309 publications

(262 citation statements)

References 11 publications

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“…Our findings suggest that using STOPP/START (ie, based on clinical evidence and integrated into Sanitas' EMR) was more consistently effective than the other tools. This makes sense: providers more consistently provide recommended care when tools that provide structure for clinical decision making, like guidelines, are used …”

Section: Discussionmentioning

confidence: 99%

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

Weeks

Mishra

Curto³

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE In nursing homes across the world, and particularly in Spain, there are concerns that psychotropic medications are being overused. For older Spanish nursing home residents who had dementia, we sought to evaluate the association between applying interventions designed to reduce inappropriate psychotropic medication use and subsequent psychotropic use. DESIGN Retrospective, propensity score–matched, controlled, patient‐level observational analysis. SETTING A total of 45 nursing homes in Spain. PARTICIPANTS A total of 1653 nursing home residents, aged 70 to 99 years, who had dementia and were prescribed an antipsychotic, anxiolytic, or antidepressant medication, 606 of whom received an intervention; the remainder served as propensity score–matched controls. INTERVENTION Team Rounds, Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria, or a Patient Decision Aid. MEASUREMENTS At 2 and 4 weeks following intervention: change from baseline drug class–specific milligram‐equivalent daily dose (MEDD); at 2 weeks: patient falls and restraint use. RESULTS Within each intervention/drug‐class cohort, intervention patients and matched controls had similar baseline demographic characteristics, Charlson scores, lengths of admission, and drug class–specific MEDDs. Compared to controls, patients exposed to Team Rounds experienced a 23.3% (95% confidence interval [CI] = 13.9%‐32.8%) reduction in antipsychotic and a 23.1% (95% CI = 18.3%‐28.0%) reduction in anxiolytic MEDDs; those exposed to Patient Decision Aids had a 24.8% (95% CI = 15.6%‐33.9%) reduction in antipsychotic and a 31.8% (95% CI = 25.5%‐38.2%) reduction in anxiolytic MEDDs; and those exposed to STOPP/START application had a 27.7% (95% CI = 22.4%‐33.0%) reduction in antipsychotic and a 39.5% (95% CI = 35.5%‐43.5%) reduction in anxiolytic MEDDs. Intervention‐associated antidepressant MEDD reductions were statistically significant but less dramatic. Interventions were associated with higher rates of medication discontinuation, but not higher rates of deaths, patient falls, or physical restraints. CONCLUSION We found strong evidence that the interventions we studied were associated with reduced psychotropic use without commensurate harms, suggesting that such interventions should be incorporated into Spanish nursing home care models. Public reporting of psychotropic medication use in Spanish care homes may encourage care homes to regularly monitor psychotropic medication use and implement such instruments. J Am Geriatr Soc, 2019.

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Section: Discussionmentioning

confidence: 99%

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

Weeks

Mishra

Curto³

et al. 2019

J American Geriatrics Society

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“…AP prescribing in individuals with dementia is still debated and recently the American Psychiatric Association issued guidelines focusing ‘on the judicious use of AP medications when agitation or psychosis occurs in association with dementia’ [15]. New evidence shows that an increased risk of death after AP prescribing is present for individuals with and without dementia, with a more pronounced risk in control participants without dementia than in individuals with dementia [16].…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Tifratene

Manera²,

Fabre

et al. 2017

Alz Res Therapy

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BackgroundSafety warnings from health authorities are currently intended to limit the use of antipsychotics (APs) in dementia-related conditions to treat neuropsychiatric symptoms, such as disturbing and/or delusional behaviors. The aim of this study is to investigate prevalence, correlates and trends of AP prescribing among people with dementia between 2010 and 2014 in the French population.MethodsAP prescribing and associated factors among individuals with AD, mixed dementia and vascular dementia in the French National Alzheimer Database between 2010 and 2014 were analyzed using multivariate generalized estimating equations models (n = 199,549).ResultsIn 2014, 7.7% of people with dementia were prescribed an AP. Compared with 2010 there was a 16% increase in AP use. Multivariate analysis showed a linear increase risk of prescription with an adjusted odds ratio (95% confidence interval) of 1.23 (1.17–1.30) in 2014 compared with 2010. Factors associated with AP prescribing were male gender, more severe cognitive decline and living in long-term care facilities. Older age and higher education were protective toward AP prescribing. The type of dementia did not have any influence on AP prescribing.ConclusionAn increase in AP prescribing among individuals with dementia in French specialized settings over the last 5 years occurred despite safety warnings. This phenomenon suggests that alternative solutions for the management of behavioral and psychiatric symptoms in these populations are still urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0256-8) contains supplementary material, which is available to authorized users.

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“…No pharmacological agents are approved for treating patients with DRP, and antipsychotic (AP) drugs are often prescribed off-label for treating psychosis despite safety concerns with use of these medications in this population (13). Meta-analyses of randomized, controlled trials of APs demonstrate limited efficacy for treating DRP (14, 15).…”

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confidence: 99%

Pimavanserin: Potential Treatment for Dementia-Related Psychosis

et al. 2018

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Psychosis is common across dementia types with a prevalence of 20% to 70%. Currently, no pharmacologic treatment is approved for dementia-related psychosis. Atypical antipsychotics are frequently used to treat these disorders, despite significant safety concerns. Pimavanserin, a selective 5-HT2A inverse agonist/antagonist, was approved in the U.S. for treating hallucinations and delusions associated with Parkinson’s disease psychosis (PDP). Patients in the pimavanserin group experienced a significant (p=0.001) improvement in Scale for the Assessment of Positive Symptoms – Parkinson’s disease (SAPS-PD) scores vs. placebo. In a subgroup analysis of patients with cognitive impairment (MMSE score ≥21 but ≤24), the observed improvement on the SAPS-PD with pimavanserin (N=50) was also significant (p=0.002) and larger than in the overall study population without an adverse effect on cognition. In a Phase 2 study with pimavanserin in Alzheimer’s disease psychosis, pimavanserin significantly (p=0.045) improved psychosis at Week 6 vs. placebo on the NPI-NH Psychosis Score (PS). In a prespecified subgroup of patients with a baseline NPI-NH PS ≥12, a substantively larger treatment effect (p=0.011) was observed vs. participants with NPI-NH PS

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The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia

Cited by 309 publications

References 11 publications

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Pimavanserin: Potential Treatment for Dementia-Related Psychosis

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