Discontinuation of Antipsychotics in Nursing Home Patients With Dementia

Abstract

The authors assessed the consequences of stopping antipsychotic medication in nursing home patients with dementia, as mandated by federal regulations (OBRA 87). They studied three patient groups: 1) a group ("clinical judgment") whose antipsychotics were discontinued at the discretion of their physicians; 2) a group ("empirical") with mandated cessation of antipsychotics in the facility; and 3) a comparison group of patients not receiving medication. The primary outcome measure was the necessity to resume antipsychotic or other psychotropic medication ("failure"). Also, assessments of behavior, function, neurologic status, and cognition were performed by blind raters. The failure rate in the empirical withdrawal group was 50%, 10 times that of the clinical judgment group. Among failures, the most striking result was increased verbal and physical aggression. No failures occurred in the comparison group. There were no benefits of antipsychotic withdrawal in terms of neurological performance, functional status, or cognition.