Treatment Of Agitation In Patients Research Articles

Masupirdine (SUVN‐502) for the Potential Treatment of Agitation in Patients with Dementia of the Alzheimer’s Type: Preliminary Efficacy and Phase‐3 Study Design

AbstractBackgroundAlzheimer’s disease (AD) is a progressive neurodegenerative disorder with manifestations in cognitive, functional and neuropsychiatric symptoms (NPS). Agitation is one of the most prevalent and challenging NPS to manage. Antipsychotics are widely used for the pharmacological management of agitation. However, they offer modest efficacy, and the side effects are substantial.Serotonin‐6 receptor (5‐HT6) blockade may have therapeutic utility in the management of disorders associated with mood and behavior. Masupirdine is a potent and selective 5‐HT6 receptor antagonist.MethodMasupirdine has been evaluated in a phase‐2, 26‐week proof‐of‐concept clinical study (NCT02580305). Subgroup analyses of study results based on the neuropsychiatric inventory scale was carried out. Masupirdine was also evaluated in animal models to assess its effect on behavior and brain neurotransmitters modulations.A double‐blind, randomized, placebo‐controlled, parallel group, adequately powered global phase‐3 study is in progress to evaluate the efficacy, safety, tolerability, and pharmacokinetics of masupirdine for the treatment of agitation in participants with dementia of the Alzheimer’s type (NCT05397639). A total of 375 patients are planned to be enrolled in the study who will be randomly assigned to receive either 50 mg masupirdine or 100 mg masupirdine or placebo. Patients will be treated for 12 weeks. The primary efficacy endpoint of this study is the Cohen‐Mansfield Agitation Inventory items score aligning to the international psychogeriatric association agitation criteria domains (physical aggression, excessive motor activity, and verbal aggression) and the key secondary endpoint is improvement in modified Alzheimer’s Disease Cooperative Study‐Clinical Global Impression of Change score as related to agitation.ResultThe observations from the post hoc analysis of phase‐2 clinical study in AD patients and animal models support the potential beneficial effects of masupirdine on agitation.The phase‐3 study has been initiated in USA and Europe, and the subject enrolment is expected to be completed by Q3 2024.ConclusionThe need for new treatments for the management of agitation is significant and unmet. The Phase‐3 study results will inform the utility of masupirdine for the potential treatment of agitation in patients with dementia of Alzheimer’s type. Phase‐3 study data readout is anticipated in Q1/Q2 2025.

Sublingual Dexmedetomidine for the Treatment of Agitation in Patients with Schizophrenia and Bipolar Disorder

Acute agitation is common amongst individuals with bipolar disorder and schizophrenia and represents a medical emergency. Commonly used medications for agitation, such as benzodiazepines and antipsychotics, are often delivered intramuscularly and may cause adverse effects. Non-invasive, effective, and safe alternative treatment options are needed. The purpose of this review article is to describe the efficacy and safety of sublingual formulation of dexmedetomidine (Igalmi), a selective α2-adrenergic receptor agonist, U.S. Food and Drug Administration approved for the treatment of acute agitation in adults with schizophrenia or bipolar I and II disorder. In two phase 3 trials, two dose strengths of sublingual dexmedetomidine 180 μg and 120 μg were safe and effective in managing acute agitation in patients with bipolar disorder or schizophrenia. Both doses significantly reduced Positive and Negative Syndrome Scale-Exited Component scores two hours after receiving a single dose as compared to placebo, indicating a substantial improvement in agitation. The beneficial effects of sublingual dexmedetomidine were achieved without serious adverse events with the most common side effect being mild somnolence. The clinical trial data suggest that sublingual dexmedetomidine represents a safe and effective treatment option in the armamentarium for acute agitation for people with schizophrenia or bipolar disorder.

Special Circumstances: Agitation with Dementia in Emergency Departments

AbstractBackgroundOlder persons presenting to the emergency department (ED) with agitation have a high prevalence of cognitive impairment which may not have been previously diagnosed.. Agitation in the ED may have many causes, one of the most prominent of which is delirium which occurs in 8–10% of older persons in the ED, and is often not diagnosed till hospital admission . The recently developed IPA algorithm for diagnosis and management of agitation in dementia is applicable to the ED environment particularly as it applies to delirium.MethodThis abstract describes the application of the IPA algorithm to the ED settingResultsOne of the major challenges of agitation management in the ED is taking a history, particularly for patients coming from a LTC environment. LTC staff can readily describe the index episode of agitation, but what is often missing is understanding the timeframe of agitation, including provoking and mitigating factors and any history of prior episodes and their causes. This makes it difficult to know if cognitive impairment is chronic or acute, the hallmark of delirium. A systematic approach to diagnosis and management is required. EDs are making increased use of well‐validated delirium screening assessments such as the Confusion Assessment Method (CAM). Other useful tools for management of delirium in the ED include ADEPT and the Delirium Triage Screen (DTS).Nonpharmacologic strategies have an important role in treatment of agitated patients in the ED. Interventions to prevent or reduce delirium in acute care environments are becoming increasingly effective: a recent Cochrane review supported the effectiveness of interventions including re‐orientation (including use of familiar objects), cognitive stimulation, sleep hygiene, attention to nutrition and hydration, oxygenation, medication review, assessment of mood, and bowel and bladder care. EDs increasingly incorporate these interventions into routine care including the use of delirium‐focused order sets and deployment of geriatric management teams which have been shown to reduce 30‐day ED readmission rates.ConclusionFurther studies should integrate diagnostic workflows and algorithms for behavioral interventions developed for both agitation and delirium management in the ED.

Inhaled Loxapine as a Rapid Treatment for Agitation in Patients with Personality Disorder: A Prospective Study on the Effects of Time.

ObjectiveAgitation in patients diagnosed with personality disorders (PD) is one of the most frequent crises in emergency departments (ED). Although many medications have been tested, their effectiveness has been small or non-significant, and no specific drugs are supported by the available evidence. This study aimed to evaluate the efficacy of Inhaled loxapine (IL) as a therapeutic option for agitated patients with PD.MethodsA naturalistic, unicentric, prospective study was carried out. Thirty subjects diagnosed with PD and attending the ED with episodes of agitation were recruited most of whom were women diagnosed with Borderline Personality Disorder. Subjects were treated with a single dose of IL (9.1 mg). Efficacy was assessed with the Clinical Global Impression scale, the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Patients were followed 60 minutes after administration to measure IL effect and its duration.ResultsIL exhibited an overall efficacy in managing mild to severe agitation, with a quick onset of effect and persistence. ‘Effect of time’, where IL efficacy is maintained over time, is more marked in higher-severity agitation. No additional treatments were needed to improve agitation during the follow-up time.ConclusionResults suggest that IL could be a safe and effective option to manage agitation in PD.

New antipsychotic drugs for the treatment of agitation and psychosis in Alzheimer's disease: focus on brexpiprazole and pimavanserin.

Behavioral and psychological symptoms of dementia are symptoms of disturbed perception, mood, behavior, and thought content that occurred frequently. These symptoms, which include apathy, depression, anxiety, psychosis, agitation, and aggression, can serve as predictors of and early clinical diagnostic markers for Alzheimer’s disease (AD) and are common precipitants of institutional care. Agitation and psychosis are associated with accelerated disease progression and increased tau phosphorylation in patients with AD. Current guidelines recommend the use of second-generation antipsychotics for the treatment of agitation and psychosis in AD, but only after first-line non-pharmacological interventions and for no longer than 12 weeks because long-term use of these drugs is associated with an increased risk of mortality and an increased frequency of cerebrovascular events. Therefore, new antipsychotic drugs with improved efficacy and safety are needed as an alternative to current antipsychotic drugs. In this report, we discuss some of the most relevant advances in the field of agitation and psychosis in AD and focus on the recent positive clinical evidence observed with two new antipsychotics drugs: brexpiprazole and pimavanserin. Brexpiprazole is a receptor partial agonist (D2, D3, 5-HT1A), receptor antagonist (5-HT2A/B, α1B/α2C) according to the neuroscience-based nomenclature. Two recent phase III clinical trials have shown that brexpiprazole 2 mg/day is effective for the treatment of agitation in patients with AD and has an improved tolerability and safety profile compared with currently available second-generation antipsychotics. Pimavanserin is a receptor antagonist (5-HT2A, 5-HT2C) that has been given market authorization for psychosis occurring in Parkinson’s disease. Recent phase II studies suggest that this drug is effective in AD patients with more severe psychosis, although further long-term studies are needed to better define the efficacy and long-term safety profile of pimavanserin for the treatment of psychosis in AD.

Investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe Alzheimer's disease: Study protocol for a cross-over randomized controlled trial.

Agitation is a prevalent and difficult-to-treat symptom in patients with moderate-to-severe Alzheimer's disease (AD). Though there are nonpharmacological and pharmacological interventions recommended for the treatment of agitation, the efficacy of these are modest and not always consistent. Furthermore, the safety profiles of currently prescribed medications are questionable. Nabilone, a synthetic cannabinoid, has a distinct pharmacological profile that may provide a safer and more effective treatment for agitation, while potentially having benefits for weight and pain. Additionally, emerging evidence suggests nabilone may have neuroprotective effects. We describe a clinical trial investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe AD. This will be a double-blind, randomized cross-over study comparing 6 weeks of nabilone (0.5–2 mg) and placebo, with a 1-week washout preceding each phase. Study outcomes will be measured at baseline and end of treatment for each treatment phase. The primary outcome measure will be agitation as assessed by the Cohen-Mansfield Agitation Inventory. The secondary outcomes include safety, behaviour (Neuropsychiatric Inventory), cognition (standardized Mini Mental Status Exam and either Severe Impairment Battery or Alzheimer's disease Assessment Scale-Cognitive subscale) and global impression (Clinician's Global Impression of Change). Exploratory outcomes include pain (Pain Assessment in Advanced AD), nutritional status (Mini-Nutritional Assessment-Short Form), caregiver distress (NPI caregiver distress), and blood-based biomarkers. A safe and efficacious pharmacological intervention for agitation, with effects on pain and weight loss in patients with moderate-to-severe AD could increase quality-of-life, reduce caregiver stress and avoid unnecessary institutionalization and related increases in health care costs.Clinical trials numberNCT02351882

ITI-007 (LUMATEPERONE) FOR THE TREATMENT OF AGITATION IN PATIENTS WITH DEMENTIA, INCLUDING ALZHEIMER'S DISEASE

Lumateperone (ITI-007) is an investigational drug that provides selective and simultaneous modulation of serotonin, dopamine, and glutamate neurotransmission. Lumateperone has a dose-dependent pharmacological profile. At low doses, lumateperone acts primarily as a potent 5-HT2A receptor antagonist with low levels of striatal D2 receptor occupancy and modest interactions with serotonin transporters and dopamine D1 receptors with indirect enhancement of glutamate. There are no currently approved treatments for agitation and aggression associated with dementia. Various medications are prescribed off-label but are frequently ineffective and associated with deleterious side effects. Given its pharmacological and clinical profile, lumateperone is currently being studied in a Phase 3 clinical trial for the treatment of agitation associated with dementia. A Positron Emission Tomography (PET) study evaluated ITI-007(10–40 mg) in healthy volunteers. Low doses of lumateperone were evaluated in patients with primary insomnia. Multiple ascending doses of lumateperone were evaluated in healthy geriatric volunteers. Repeated daily doses of lumateperone were evaluated for safety in patients with dementia. In the PET study, ITI-007 (10 mg) demonstrated high occupancy (>80 %) of cortical 5-HT2A receptors and low occupancy of striatal D2 receptors (∼12 %). In a Phase 2 trial in patients with primary insomnia, ITI-007 (1 – 10 mg) was shown to restore natural sleep patterns with no next-day hang-over effects. A study in healthy elderly subjects showed that low doses of ITI-007 (7.5, 15.0 and 30 mg, QAM for 7 days) were safe and well-tolerated and showed no clinically significant impact on the extrapyramidal, endocrine, and cardiovascular systems. In elderly patients with dementia, ITI-007 was safe and well-tolerated and improved measures of cognition. Lumateperone represents a potential new approach for the treatment of a broad array of neuropsychiatric symptoms, including the treatment of agitation in patients with dementia. Not only is there evidence to suggest improvements in sleep, cognition, learning and behavioral disturbances, but ITI-007’s benign safety and tolerability profile would make it an important novel and safe treatment option for this patient population.

Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in Nursing Home Residents With Alzheimer Dementia

ObjectiveTo assess efficacy and safety of citalopram compared to quetiapine and olanzapine for the treatment of agitation in patients with Alzheimer disease (AD). DesignLongitudinal, 6-month study. SettingNursing home (NH). Participants75 NH residents with AD and agitation, randomized to citalopram (n = 25), quetiapine (n = 25), or olanzapine (n = 25). MeasurementsChanges in Neuropsychiatric Inventory (NPI) agitation subscale score and the modified Alzheimer Disease Cooperative Study–Clinical Global Impression of Change (mADCS-CGIC) were used to assess treatment efficacy. Participants were surveilled for adverse health outcomes. ResultsCitalopram treatment (30±5.8 mg/d) resulted in similar 6-month efficacy compared to both quetiapine (94.0±40.4 mg/d) and olanzapine (5.2±1.6 mg/d), lower occurrence of falls than olanzapine [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.68-0.97, P = .012], lower incidence of orthostatic hypotension than both quetiapine (OR = 0.80, 95% CI = 0.66-0.95, P = .032) and olanzapine (OR = 0.75, 95% CI = 0.69-0.91, P = .02), and less all-cause hospitalizations than both quetiapine (OR = 0.92, 95% CI = 0.88-0.95, P = .016) and olanzapine (OR = 0.78, 95% CI = 0.64-0.92, P = .004), after multiple adjustment for potentially confounding variables. No differences were observed for cognitive and functional decline, QTc prolongation, and infections. ConclusionsCitalopram resulted in similar efficacy and less adverse outcomes when compared to 2 atypical antipsychotics for treatment of agitation in NH residents with AD. Replication of these findings and assessment of long-term efficacy and safety of citalopram for treatment of neuropsychiatric symptoms in dementia are needed.

Patient preferences for medicine administration for acute agitation: results from an internet-based survey of patients diagnosed with bipolar disorder or schizophrenia in two Nordic countries

The objective was to elicit patient preferences for medicine administration method in the management of acute agitation episodes among patients diagnosed with bipolar disorder or schizophrenia. The patients’ experiences of acute agitation episodes and their management of episodes were also explored. Data were collected via an anonymous, internet-based survey of residents in Denmark or Sweden with schizophrenia or bipolar disorder (October 2014 to December 2014). Inclusion criteria were having a diagnosis of schizophrenia or bipolar disorder, and being above 18 years of age. The questionnaire included questions about preferences for medication attributes, experiences with pharmacological treatment for agitation and involvement in treatment plans. A total of 237 diagnosed patients (61 with schizophrenia; 176 with bipolar disorder) completed the questionnaire. Agitation episodes were experienced by 90% of the respondents. In total, 83% of the respondents reported having received treatment with tablets. When patients were presented with the attributes of an inhalation method, respondents stated that the fast onset of action, low risk of adverse reactions and least invasive form of drug delivery were positive attributes of treatment with inhalation. Inhalation is a new delivery route for treatment of acute agitation in patients diagnosed with bipolar disorder or schizophrenia. Inhalation is the preferred treatment method for acute agitation among Danish and Swedish patients with bipolar disorder or schizophrenia.

Electroconvulsive therapy (ECT) for treating agitation in dementia (major neurocognitive disorder) - a promising option.

Agitation in patients with dementia increases caretaker burden, increases healthcare costs, and worsens the patient's quality of life. Antipsychotic medications, commonly used for the treatment of agitation in patients with dementia have a box warning from the FDA for elevated mortality risk. Electroconvulsive therapy (ECT) has made significant advances over the past several years, and is efficacious in treating a wide range of psychiatric conditions. We provide a systematic review of published literature regarding the efficacy of ECT for the treatment of agitation in patients with dementia (major neurocognitive disorder). We searched PubMed, Medline, Google Scholar, UptoDate, Embase, and Cochrane for literature concerning ECT for treating agitation in dementia using the title search terms "ECT agitation dementia;" "ECT aggression dementia;" "ECT Behavior and Psychological Symptoms of Dementia;" and "ECT BPSD." The term "dementia" was also interchanged with "Major Neurocognitive Disorder." No time frame restriction was placed. We attempted to include all publications that were found to ensure a comprehensive review. We found 11 papers, with a total (N) of 216 patients. Limited to case reports, case series, retrospective chart review, retrospective case-control, and an open label prospective study, ECT has demonstrated promising results in decreasing agitation in patients with dementia. Patients who relapsed were found to benefit from maintenance ECT. Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome measures, and less selection bias of the study sample that may favor treatment response, is warranted. ECT may be a promising option for the treatment of aggression and agitation in patients with severe dementia who are refractory to other treatment options, but the limitations of available studies suggest that a cautious approach to future randomized controlled trials is warranted.

Guideline Watch (October 2014): Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias.

(Reprinted with permission from American Psychiatric Association, http://psychiatryonline.org/guidelines).

Antipsychotic Selection for Acute Agitation and Time to Repeat Use in a Psychiatric Emergency Department.

Early recognition and treatment of agitated patients is essential to avoid violence in the psychiatric emergency department (ED). Antipsychotics have established efficacy in managing agitation, yet little is known about how the choice of initial antipsychotic impacts time to repeat use and length of stay (LOS) in the psychiatric ED. To describe the impact of initial antipsychotic selection on time to repeat use and LOS in the psychiatric ED. A chart review identified 388 cases in which patients were administered an antipsychotic for agitation in the psychiatric ED between July 1 and August 31, 2014. Time to repeat use and LOS were compared for intramuscular (IM) haloperidol, other IM antipsychotics, and oral second-generation antipsychotics (SGAs) using the Kruskal-Wallis or Wilcoxon-Mann-Whitney test. Of the 388 cases, 31% (n=122) required repeat medications. Mean time to repeat use for IM haloperidol was 20.1±18.4 hours, which was not significantly different from mean time to repeat use in the groups receiving other IM antipsychotics or oral SGAs (P=0.35). The mean LOS was 29.7±28.7 hours for IM haloperidol, 30.3±36.9 hours for other IM antipsychotics, and 22.6±28.0 hours for oral SGAs. Significant differences in LOS between repeat and nonrepeat users of IM haloperidol and other IM antipsychotics were observed, but not among those who received oral SGAs. Mean time to repeat use ranged from 14 to 20 hours with IM haloperidol, other IM antipsychotics, and oral SGAs without significant differences in time to repeat use in the 3 different groups. Repeat users of IM antipsychotics had a significantly longer LOS in the ED compared with nonrepeat users of IM antipsychotics. However, patients who were initially administered oral SGAs did not have longer LOS in the ED even if a repeat dose was given.

Intramuscular olanzapine versus intramuscular aripiprazole for the treatment of agitation in patients with schizophrenia: A pragmatic double-blind randomized trial

ObjectiveTo evaluate and compare the effectiveness and adverse effects of intramuscular (IM) olanzapine and IM aripiprazole for the treatment of agitated patients with schizophrenia in clinical practice. MethodsA 24-hour randomized double-blind study carried out at a psychiatric hospital in Thailand enrolled adult patients (18–65years old) with schizophrenia experiencing agitation. Patients received one dose of IM olanzapine or IM aripiprazole followed by routine oral psychotropic medications. Efficacy was primarily measured using the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). ResultsA total of 80 patients with a PANSS-EC score range of 22–35 entered the study, of whom 13% had a medical comorbidity and 40% a history of active substance abuse. The 40 patients receiving IM olanzapine showed greater improvement than the 40 patients receiving IM aripiprazole in PANSS-EC scores at 2h after the injection (p=0.002) but not at 24h. The two treatments were well tolerated. Patients receiving IM olanzapine experienced greater somnolence than those receiving IM aripiprazole. There were no clinically relevant changes in vital signs in either group. ConclusionThe results indicate that IM olanzapine and aripiprazole are similarly effective and well tolerated in the real-world treatment of agitation associated with schizophrenia over the first 24h. However, in the early hours, IM olanzapine may produce more sedation and reductions in agitation.

DESIGNING A RANDOMIZED PLACEBO-CONTROLLED CROSSOVER TRIAL INVESTIGATING NABILONE AS A TREATMENT FOR AGITATION IN PATIENTS WITH MODERATE-TO-SEVERE ALZHEIMER’S DISEASE

DESIGNING A RANDOMIZED PLACEBO-CONTROLLED CROSSOVER TRIAL INVESTIGATING NABILONE AS A TREATMENT FOR AGITATION IN PATIENTS WITH MODERATE-TO-SEVERE ALZHEIMER’S DISEASE

Poster Number: EI 54 - Electroconvulsive Therapy (ECT) for Treating Agitation in Dementia (Major Neurocognitive Disorder)—a Promising Option

Background Agitation in patients with increases caretaker burden, increases healthcare costs, and worsens the patient's quality of life. Antipsychotic medications, commonly used for the treatment of agitation in patients with have a box warning from the FDA for elevated mortality risk. Electroconvulsive therapy (ECT) has made significant advances over the past several years, and is efficacious in treating a wide range of psychiatric conditions. We provide a systematic review of published literature regarding the efficacy of for the treatment of agitation in patients with (major neurocognitive disorder). Methods We searched PubMed, Medline, Google Scholar, UptoDate, Embase, and Cochrane for literature concerning for treating agitation in using the title search terms ECT agitation dementia; ECT aggression dementia; ECT Behavior and Psychological Symptoms of Dementia; and ECT BPSD. The term dementia was also interchanged with Major Neurocognitive Disorder. No time frame restriction was placed. We attempted to include all publications that were found to ensure a comprehensive review. We found 11 papers, with a total (N) of 216 patients. Results Limited to case reports, case series, retrospective chart review, retrospective case-control, and an open label prospective study, has demonstrated promising results in decreasing agitation in patients with dementia. Patients who relapsed were found to benefit from maintenance ECT. Conclusions Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome measures, and less selection bias of the study sample that may favor treatment response, is warranted. may be a promising option for the treatment of aggression and agitation in patients with severe who are refractory to other treatment options, but the limitations of available studies suggest that a cautious approach to future randomized controlled trials is warranted.

Treatment of bipolar patients in manic phase: A comparison between asenapine and aripiprazole

IntroductionAgitation is the most evident symptom in an acute manic episode. It can be defined as excessive motor or verbal activity that can degenerate into aggressive behaviour. Both aripiprazole and asenapine are indicated for the treatment of agitation in patients with manic episode.AimsTo retrospectively evaluate the acute effects of drug therapy on psychomotor agitation rated with the PANSS-EC, the change in manic symptoms through the YMRS, the QoL with the SF-36v2 and the cardiometabolic effects of the new oral APS.MethodsWe administered the following tests to 13 patients with DBI at T0 (baseline), T1 (after 1 week), T2 (after 4 weeks), T3 (after 12 weeks) and T4 (after 24 weeks): PANSS-EC, YMRS, SF-36v2, CGI-BD, CGI-S, HAM-D, BPRS. We also considered weight, height, BMI, ECG and complete blood count.ResultsPatients recruitment and statistical analyses are still in progress. Our preliminary results suggest that there is not a marked difference between the two drugs. We highlighted that there has been a noticeable decrease in results at PANSS as well as at YMRS from T0 to T4 and patients showed an improvement in QoL. Only one patient treated with asenapine showed an increase in the results of HAM-D.ConclusionsResults suggest the efficacy of the two new APS but further recruitment and data collection are needed to better understand their impact on agitation and QoL, including the metabolic profile, with the aim to help clinicians to make a more accurate choice of drug for each specific patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Dextromethorphan Plus Quinidine Helps Quell Agitation

norepinephrine, and possibly other old with probable Alzheimer’s disease, group continued receiving the drug neurotransmitters. clinically significant agitation, and combination in stage 2, whereas the plaPublished in the Journal of the Mini-Mental State Examination score cebo group was stratified by response American Medical Association, the findof 8–28. Clinically significant agitation and re-randomized in a 1:1 ratio to ings are from a 10-week, 42-center was defined as poorly organized and dextromethorphan-quinidine (n = 59) double-blind, placebo-controlled study purposeless psychomotor activity and or placebo (n = 60). A Clinical Global led by Jeffrey L. Cummings, MD, ScD, aggressive verbal, aggressive physical, or Impressions-Severity (CGIS) agitation from the Cleveland Clinic Lou Ruvo nonaggressive physical behaviors. score up to 3 and a decrease of at least Center for Brain Health, Las Vegas In stage 1 of the trial, participants 25% in the Neuropsychiatric Inventory (JAMA 2015;314:1242–54.). Conducted were randomized in a 3:4 ratio to receive (NPI) Agitation/Aggression domain from August 2012 to August 2014, the dextromethorphan-quinidine (n = 93) or score constituted a response to treattrial enrolled 1,220 patients 50–90 years placebo (n = 127). The active treatment ment at the end of stage 1. Dextromethorphan Plus Quinidine Helps Quell Agitation

Dextromethorphan/quinidine (AVP-923) for treatment of agitation in patients with Alzheimer’s disease: Analysis of week 10 results for patients treated only with AVP-923 versus patients receiving only placebo (NCT01584440)

Dextromethorphan/quinidine (AVP-923) for treatment of agitation in patients with Alzheimer’s disease: Analysis of week 10 results for patients treated only with AVP-923 versus patients receiving only placebo (NCT01584440)

Case Reports of Inhaled Loxapine in the Treatment of Agitated Patients

Agitation is a broadly defined phenomenon that is associated with many physical and mental illnesses. The core features of agitation generally include: irritability, excessive or semi purposeful motor activity, heighted responsiveness to internal and external stimuli and an unstable course. Inhaled Loxapine is recently available as a new approach in the management of these episodes. To present case reports of Inhaled Loxapine in the treatment of agitated patients in our clinic. We have selected representative case reports form our acute unit characterizing the patients´ history and the circumstances of present admission, the evolution and the management of these episodes during the admission. Inhaled loxapine as a new treatment option allows rapid control of agitation in these unstable patients who can suddenly turn into aggression or violence, facilitating the therapeutic alliance between the patient and physician without resorting to mechanical or physical restraint.

Case Reports of Inhaled Loxapine in the Treatment of Agitated Patients

Case Reports of Inhaled Loxapine in the Treatment of Agitated Patients