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Antipsychotics in geriatric

So Kirino, Takefumi Suzuki, Hiroyoshi Takeuchi, Masaru Mimura, Hiroyuki Uchida
While positron emission tomography (PET) studies have provided invaluable data on antipsychotic effects, selection bias remains a serious concern. A systematic review of PET studies that measured dopamine D2 receptor blockade with antipsychotics was conducted to examine their inclusion/exclusion criteria, using PubMed, EMBASE, and (last search, September 2016). PET studies were included if they measured D2 receptor occupancy in patients with schizophrenia and included introduction of antipsychotic treatment or antipsychotic regimen change in a systematic manner...
January 5, 2017: Journal of Psychiatric Research
Nina L Blachman, Rosanne M Leipzig, Madhu Mazumdar, Jashvant Poeran
OBJECTIVES: To examine dosages of high-risk medications administered to elderly adults who fall in the hospital and to determine whether electronic default doses are appropriate for elderly adults. DESIGN: Retrospective. SETTING: Large urban academic hospital. PARTICIPANTS: Individuals aged 65 and older experiencing a fall. MEASUREMENTS: Prescribed daily dosages and use of high-risk medications (opiates, benzodiazepines, benzodiazepine-receptor agonists (BRAs), sleep medications, muscle relaxants, antipsychotics) administered within 24 hours before a fall were ascertained and compared with published recommended dosages for older adults and the hospital's electronic medical record (EMR) default doses for these drugs...
November 28, 2016: Journal of the American Geriatrics Society
Mirko Di Rosa, Paolo Fabbietti, Andrea Corsonello, Sergio Fusco, Federica Sganga, Stefano Volpato, Carmelinda Ruggiero, Graziano Onder, Fabrizia Lattanzio
AIM: Several factors can affect antipsychotic prescriptions, among which, caregivers. However, whether being assisted by a care worker might increase the rate of antipsychotic prescriptions at discharge from acute care hospital has not been previously investigated. We aimed to investigate whether being assisted by a care worker is associated with increased use of antipsychotics among older patients discharged from acute care hospitals. METHODS: The present series consisted of 928 patients not taking antipsychotics at admission in seven acute care wards of geriatric medicine in Italy (mean age 80...
November 10, 2016: Geriatrics & Gerontology International
Jennifer L Schroeck, James Ford, Erin L Conway, Kari E Kurtzhalts, Megan E Gee, Krista A Vollmer, Kari A Mergenhagen
PURPOSE: Insomnia is problematic for older adults. After behavioral modifications fail to show adequate response, pharmacologic options are used. The pharmacokinetics of agents used to treat insomnia may be altered. This review focuses on the safety and efficacy of medications used to treat insomnia. METHODS: A literature search of Medline, PubMed, and Embase was conducted (January 1966-June 2016). It included systematic reviews, randomized controlled trials, observational studies, and case series that had an emphasis on insomnia in an older population...
November 2016: Clinical Therapeutics
X Jégouzo, M Desbordes, S Delègue, G Le Vacon, M Patrick, S Mouchabac
OBJECTIVES: Behavioral and psychological symptoms have a high prevalence in dementia. They include mood disorders, psychotic disorders and behavioral disorders such as aggression or screaming. Despite a number of side effects and an increased mortality, antipsychotic drugs are widely prescribed for treatment of this disorder. In France, this increased risk of mortality led in 2009 to the adoption of guidelines concerning all antipsychotics. The guidelines propose a sensible use of antipsychotics after the establishment of non-pharmacological measures...
October 12, 2016: L'Encéphale
Sibel Cakir, Zeynep Senkal
BACKGROUND: Second-generation antipsychotics (SGAs) have been used in the augmentation of treatment-resistant depression. However, little is known about their effectiveness, tolerability, and adverse events in the treatment of late-life depression, which were the aim of this study. METHODS: The retrospective data of patients aged >65 years who had a major depressive episode with inadequate response to antidepressant treatment and had adjuvant SGA treatment were analyzed...
2016: Clinical Interventions in Aging
Gulistan Bahat, Ilker Bay, Asli Tufan, Fatih Tufan, Cihan Kilic, Mehmet Akif Karan
AIM: To date, there is no study comparing the Beers 2012 and Screening Tool of Older Person's Prescriptions (STOPP) version 2 criteria, nor reporting a comparison of the prevalence of potentially inappropriate Prescribing (PIM) with STOPP version 2. We aimed to evaluate the prescriptions of patients admitted to a geriatric outpatient clinic with these tools, and to document the factors related to PIM use. METHODS: Older patients (aged ≥65 years) admitted to the outpatient clinic of a university hospital were retrospectively evaluated for PIM with Beers 2012 and STOPP version 2 criteria...
August 10, 2016: Geriatrics & Gerontology International
Giuseppe Bellelli, Alessandro Morandi, Simona G Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Mario Bo, Angelo Bianchetti, Renzo Rozzini, Ermellina Zanetti, Massimo Musicco, Alberto Ferrari, Nicola Ferrara, Marco Trabucchi
BACKGROUND: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy...
July 18, 2016: BMC Medicine
Kannayiram Alagiakrishnan
Melatonin levels have been shown to decline with aging. Melatonin and its analogs in addition to their effect on sleep promotion, has been shown to have multiple pleiotropic effects. It can also help with neuroprotection through different mechanisms. Evidence in animal and human studies suggests that low levels of melatonin have been linked to delirium, mild cognitive impairment, dementia, and with certain behavioral problems. Recent clinical trials have showed that both melatonin and its analogs may be useful in the prevention, treatment of delirium, and the management of dementia...
May 2016: Discovery Medicine
Christian Jagsch, Gabriele Dietmaier, Maximilian Jagsch, Martin Kurz
BACKGROUND: The objective of this study was to survey the consistency of the clinical diagnostics and the psychopharmacological treatment of schizophrenia and delusional disorders suffered by older persons. A further aspect was to record significant clinical differences and also similarities between the patient groups in care, matching with the criteria of ICD 10 for schizophrenia (F20), persistent delusional disorders (F22) and schizoaffective disorder (F25). METHODS: Retrospective analysis with reference to the manually and electronically recorded patient medical records of an acute case care ward for geriatric psychiatry and psychotherapy...
June 2016: Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation
Avantika A Saraf, Alec W Petersen, Sandra F Simmons, John F Schnelle, Susan P Bell, Sunil Kripalani, Amy P Myers, Amanda S Mixon, Emily A Long, J Mary Lou Jacobsen, Eduard E Vasilevskis
BACKGROUND: More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than 3 geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. OBJECTIVES: Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to SNFs. DESIGN: Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis...
October 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Robert Briggs, Emma O'Shea, Ana de Siún, Desmond O'Neill, Paul Gallagher, Suzanne Timmons, Sean Kennelly
OBJECTIVE: The objective of this study is to clarify if admission to a specialist geriatric medicine ward leads to improvements in aspects of acute medical care for patients with dementia. METHODS: We analysed combined data involving 900 patients from the Irish and Northern Irish audits of dementia care. Data on baseline demographics, admission outcomes, clinical aspects of care, multidisciplinary assessment and discharge planning processes were collected. RESULTS: Less than one-fifth of patients received their inpatient care on a specialist geriatric medicine ward...
May 19, 2016: International Journal of Geriatric Psychiatry
Linda Simoni-Wastila, Yu-Jung Wei, Judith A Lucas, Nicole Brandt, Patience Moyo, Ting-Ying J Huang, Christine S Franey, Ilene Harris
OBJECTIVES: To examine disease-specific associations between antipsychotic dose and duration and all-cause mortality. DESIGN: Retrospective cohort study. SETTING: A 5% random sample of Medicare beneficiaries who had a Minimum Data Set 2.0 clinical assessment completed between 2007 and 2009. PARTICIPANTS: Three mutually exclusive cohorts of new antipsychotic users with evidence of severe mental illness (SMI, n = 5,621); dementia with behavioral symptoms (dementia + behavior) without SMI (n = 1,090); or delirium only without SMI or dementia + behavior (n = 2,100) were identified...
May 2016: Journal of the American Geriatrics Society
Iwona Otremba, Krzysztof Wilczyński, Jan Szewieczek
BACKGROUND: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. OBJECTIVE: Evaluate specific factors for development of delirium in a geriatric ward setting. METHODS: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission...
2016: Clinical Interventions in Aging
Pinar Soysal, Ali Ekrem Aydin, Saadet Koc Okudur, Ahmet Turan Isik
Detection of orthostatic hypotension (OH) is very important in geriatric practice, since OH is associated with mortality, ischemic stroke, falls, cognitive failure and depression. It was aimed to determine the most appropriate time for measuring blood pressure in transition from supine to upright position in order to diagnose OH in elderly. Comprehensive geriatric assessment (CGA) including Head up Tilt Table (HUT) test was performed in 407 geriatric patients. Orthostatic changes were assessed separately for the 1st, 3rd and 5th minutes (HUT1, HUT3 and HUT5, respectively) taking the data in supine position as the basis...
July 2016: Archives of Gerontology and Geriatrics
Maria Gustafsson, Ulf Isaksson, Stig Karlsson, Per-Olof Sandman, Hugo Lövheim
PURPOSE: The use of psychotropic drugs to treat behavioral and psychological symptoms among people with dementia has been widely questioned because of its limited efficacy and risk of harmful side-effects. The objectives of this study was to compare the prevalence of behavioral and psychological symptoms and the use of psychotropic drug treatments among old people with cognitive impairment living in geriatric care units in 2007 and 2013. METHODS: Two questionnaire surveys were performed in 2007 and 2013, comprising all those living in geriatric care units in the county of Västerbotten in northern Sweden...
August 2016: European Journal of Clinical Pharmacology
Sahar Sajadi, Ching Yu, Jean-Daniel Sylvestre, Karl J Looper, Marilyn Segal, Soham Rej
BACKGROUND: Exposure to psychotropic agents, including lithium, antipsychotics and antidepressants, has been associated with nephrogenic diabetes insipidus (NDI). This is especially concerning in older adults already at risk of developing chronic kidney disease (CKD) and hypernatremia with advanced aging. This study investigates whether commonly performed random urine-specific gravity (USG) tests can predict adverse NDI outcomes (CKD and hypernatremia) in psychotropic-exposed older adults...
April 2016: Clinical Kidney Journal
Dvora Frankenthal, Gisele Zandman-Goddard, Yael Ben-Muvhar, Bat Sheva Porat-Katz
BACKGROUND: Antipsychotic medications (APMs) are commonly prescribed in nursing homes (NHs) and their excessive use raises concerns about the quality of care. They are often seen as "chemical restraints", and were shown to increase morbidity and mortality risks in NH residents. The objective of this study was to investigate the variability in prevalence in APM use in a sample of Israeli NHs and to examine the effect of facility characteristics on the use of APMs. METHODS: A retrospective cross-sectional study was conducted in 2011 using data which were collected in a sample of NHs in the Tel Aviv district during the annual certification process...
2016: Israel Journal of Health Policy Research
Najma Siddiqi, Jennifer K Harrison, Andrew Clegg, Elizabeth A Teale, John Young, James Taylor, Samantha A Simpkins
BACKGROUND: Delirium is a common mental disorder, which is distressing and has serious adverse outcomes in hospitalised patients. Prevention of delirium is desirable from the perspective of patients and carers, and healthcare providers. It is currently unclear, however, whether interventions for preventing delirium are effective. OBJECTIVES: To assess the effectiveness of interventions for preventing delirium in hospitalised non-Intensive Care Unit (ICU) patients...
March 11, 2016: Cochrane Database of Systematic Reviews
Xavier Vidal, Antonia Agustí, Antoni Vallano, Francesc Formiga, Antonio Fernández Moyano, Juana García, Alfonso López-Soto, Nieves Ramírez-Duque, Olga H Torres, José Barbé, Antonio San-José
PURPOSE: The purpose of this study is to describe the characteristics of older patients treated with psychotropic medicines and the associated factors and to assess their inappropriate use. METHODS: An observational, prospective study was carried out in 672 elderly patients admitted to seven hospitals for a year. A comparison of sociodemographic characteristics, geriatric variables, multimorbidity and the number of prescribed medicines taken in the preceding month before hospitalization between patients treated with psychotropics and those not treated was performed...
June 2016: European Journal of Clinical Pharmacology
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