Use Of Antipsychotics In Patients Research Articles

Partial regimen replacement with aripiprazole reduces serum prolactin in patients with a long history of schizophrenia: A case series.

Aripiprazole (ARP) is a popular antipsychotic drug that has demonstrated ameliorative effects on hyperprolactinemia. However, no study to date has studied the utility of ARP in patients with a long history of schizophrenia and antipsychotic treatment. We therefore examined the effect of partial antipsychotic regimen replacement with ARP on hyperprolactinemia induced by chronic antipsychotic use in patients with schizophrenia. Sixteen patients with a schizophrenia diagnosis (F2) based on the International Classification of Diseases (version 10) were recruited. At months 0, 1, 3, and 6 of the study, serum prolactin, body weight, and blood glucose were measured, and QOL and psychotic symptoms were assessed using Global Assessment of Functioning scores and Clinical Global Impressions of Improvement (CGI-I) scores. Nine patients with an average age of 46.7±9.6 years and mean disease duration of 15.9±10.4 years were included in the final analysis. Serum prolactin levels significantly decreased and GAF and CGI-I scores improved significantly over the 6-month period after partial replacement with ARP. Additionally, no changes were observed in body weight or blood glucose over the 6-month period. Partial antipsychotic regimen replacement with ARP improves hyperprolactinemia, and may improve the QOL of patients with a long history of schizophrenia. Japan Medical Association, Center for clinical trials D: JMA-IIA00245.

Acute laryngeal dystonia: a persisting psychiatric emergency

Acute laryngeal dystonia is one of the most life-threatening medication side effects in psychiatry. It is rare and predominately caused by the use of antipsychotics in at-risk individuals. Within days of a patient's initial presentation, several antipsychotics can be administered for the purposes of acute sedation and ongoing pharmacotherapy. In this case report, we describe a 27-year-old at-risk male, who developed acute laryngeal dystonia in the context of antipsychotic polypharmacy. Clinicians should take into account recent sedation and ongoing antipsychotic use in patients at risk of developing acute laryngeal dystonia. Awareness of this condition and prompt treatment with parenteral anticholinergic medication can be lifesaving.

Association of Antipsychotic Use With Mortality Risk in Patients With Parkinson Disease.

As many as 60% of patients with Parkinson disease (PD) experience psychosis, 80% develop dementia, and the use of antipsychotics (APs) in the population with PD is common. The use of APs by patients with dementia in the general population is associated with increased mortality, but whether this risk extends to patients with PD remains unknown. To determine whether AP use in patients with PD is associated with increased mortality. This retrospective matched-cohort study used data from a Veterans Health Administration database from fiscal years 1999 to 2010 to examine the risk associated with AP use in a cohort of patients with idiopathic PD and recent stable physical health. The rates of 180-day mortality were compared in 7877 patients initiating AP therapy and 7877 patients who did not initiate AP therapy (matched for age ±2.5 years, sex, race, index year, presence and duration of dementia, PD duration, delirium, hospitalization, Charlson Comorbidity Index, and new nonpsychiatric medications). Data were analyzed from October 19, 2012, to September 21, 2015. Mortality rates at 180 days in those patients who initiated AP therapy compared with matched patients who did not use APs. Cox proportional hazards regression models were used with intent-to-treat (ITT) and exposure-only analyses. The study population included 7877 matched pairs of patients with PD (65 women [0.8%] and 7812 men [99.2%] in each cohort; mean [SD] age, 76.3 [7.7] years for those who initiated AP therapy and 76.4 [7.6] years for those who did not). Antipsychotic use was associated with more than twice the hazard ratio (HR) of death compared with nonuse (ITT HR, 2.35; 95% CI, 2.08-2.66; P < .001). The HR was significantly higher for patients who used typical vs atypical APs (ITT HR, 1.54; 95% CI, 1.24-1.91; P < .001). Among the atypical APs used, HRs relative to nonuse of APs in descending order were 2.79 (95% CI, 1.97-3.96) for olanzapine, 2.46 (95% CI, 1.94-3.12) for risperidone, and 2.16 (95% CI, 1.88-2.48) for quetiapine fumarate. Use of APs is associated with a significantly increased mortality risk in patients with PD, after adjusting for measurable confounders. This finding highlights the need for cautious use of APs in patients with PD. Future studies should examine the role of nonpharmacologic strategies in managing psychosis in PD. In addition, new pharmacologic treatments that do not increase mortality in patients with neurodegenerative diseases need to be developed.

Poster Number: EI 20 - Antipsychotic Prescribing Patterns in a Medicare Advantage Population of Older Individuals with Dementia

AbstractBackground: Antipsychotic medications are widely used to treat behavioral symptoms of dementia. However, studies have shown that antipsychotic use in patients with dementia is associated with risk of side effects.Aims: The aim of this study is to examine antipsychotic prescribing patterns for beneficiaries with dementia enrolled in a Medicare Advantage program and identify opportunities to improve prescribing practices.Methods: This study includes Medicare Advantage beneficiaries who were 65 years of age or older with dementia. We examined the number of participants that were prescribed an antipsychotic medication. Descriptive analysis was performed, and logistic regression models were used to describe the correlates of antipsychotic exposure.Results: Of the 8688 individuals in the Medicare Advantage population with a dementia diagnosis, 1061 (12.2%) received an antipsychotic medication. Correlates of receiving an antipsychotic medication included older age, dual eligibility for Medicare and Medic...

The use of antipsychotics among people treated with medications for dementia in residential aged care facilities.

Antipsychotic agents have limited efficacy for Behavioral and Psychological Symptoms of Dementia (BPSD) and there are concerns about their safety. Despite this, they are frequently used for the management of BPSD. This study aimed to assess the use of antipsychotics among people on anti-dementia medicines in Australian residential aged care facilities. Data were obtained from an individual patient unit dose packaging database covering 40 residential aged care facilities in New South Wales, Australia. Residents supplied an anti-dementia medicine between July 2008 and June 2013 were included. Prevalence of concurrent antipsychotic use was established. Incident antipsychotic users between January 2009 and December 2011 were identified. We examined initial antipsychotic dose, maximum titrated doses, type and duration of antipsychotic use, and compared use with Australian guidelines. There were 291 residents treated with anti-dementia medicines, 129 (44%) of whom received antipsychotics concomitantly with an anti-dementia medicine. Among the 59 incident antipsychotic users, risperidone (73%) was the most commonly used antipsychotic agent. Amongst the risperidone initiators, 43% of patients had initial doses greater than 0.5 mg/day and 6% of patients exceeded 2.0 mg/day for their maximum dose. 53% of concomitant users received daily treatment for greater than six months. Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.

Factors Associated With Hyperphagic Behavior in Patients With Dementia Living at Home.

To investigate the prevalence and patterns of and factors associated with hyperphagic behavior in Taiwanese patients with dementia living at home. A cross-sectional and correlational design was used. A total of 104 patients with dementia and their primary caregivers were recruited from the geriatric, neurology, and memory clinics of a regional hospital, a medical center and two day-care centers in central Taiwan. The data related to hyperphagic behavior, functional abilities, medical conditions, body weight, and demographic characteristics of patients as well as the demographic characteristics of their primary caregivers were collected between January and May 2013. Based on a strict criterion (a median score of 3 for the hyperphagic subscale), the prevalence of hyperphagia in patients with dementia was 53.8%. Specific hyperphagic patterns exhibited included increased food intake (49% of patients with dementia), hoarding (8.7%), oral exploration (6.8%), and pica (3.9%). Years of education of the patient, the use of antipsychotics in patients, and the age of primary caregivers explained 16.3% of the variance in hyperphagic behavior subscale scores (F = 6.47, p < .001). For the early identification and treatment of hyperphagic behavior in patients with dementia in home care or in clinic services provided by health professionals, specific attention should be paid to the usual eating behaviors of patients with lower levels of education or who are taking antipsychotic medication or those who have a female primary caregiver.

Pharmacotherapy of Co-Occurring Schizophrenia and Substance Use Disorders.

Substance use disorders, common in patients with schizophrenia, can lead to poor outcomes. Here we review the literature on the use of antipsychotics in patients with co-occurring schizophrenia and substance use disorder as well as evidence for the use of adjunctive pharmacological treatments targeting substance use in these patients. We also discuss a neurobiological formulation suggesting that the cooccurrence of these disorders may be related to a dysfunction in the dopamine mediated brain reward circuitry. Typical antipsychotics do not appear to decrease substance use in this population. Randomized, controlled trials provide some support for use of the atypical antipsychotic clozapine for co-occurring cannabis use disorder, naltrexone and disulfiram for alcohol use disorder, and also nicotine replacement therapy, sustained-release bupropion and varenicline for tobacco use disorder. Nonetheless, data regarding treatment in patients with these co-occurring disorders are still limited, and many studies reported to date have been either underpowered or did not include a control condition. Further research is needed to evaluate optimal pharmacotherapeutic strategies for this population.

Trends in use of psychotropic medications among patients treated with cholinesterase inhibitors in Japan from 2002 to 2010.

We aimed to examine trends in the use of psychotropic medications among elderly outpatients with dementia in Japan between 2002 and 2010. We used data from the 2002-2010 Survey of Medical Care Activities in Public Health Insurance (SMCA-PHI), a nationally representative cross-sectional survey of claims data for the month of June in every year. We included ambulatory care visits by patients aged 65 years or older who were prescribed cholinesterase inhibitors (n = 15,591), and identified use of any psychotropic medications during the survey month. In 2008–2010, the most prevalently prescribed psychotropic medications to patients with dementia were sedatives-hypnotics (27.3%), antipsychotics (21.3%), antidepressants (11.4%), and mood-stabilizers(2.8%). Between 2002–2004 and 2008–2010, use of second-generation antipsychotics increased from 4.9%to 11.2%, while use of first-generation antipsychotics decreased from 17.4% to 12.1% [corrected].These numbers resulted in a 1.1-fold increase in the adjusted prevalence of the overall use of antipsychotics. Quetiapine and risperidone use showed a 4.8- and 1.8-fold increase, respectively, while haloperidol use showed a 2.3-fold decrease. Despite safety warnings against the use of antipsychotics for patients with dementia in several countries, our study revealed a slight increase in the extensive use of off-label antipsychotics over time in Japan. This finding indicates an urgent need for evaluation of the efficacy of antipsychotics for the approved treatment of severe agitation, aggression, and psychosis associated with dementia. Moreover, psychosocial interventions and antipsychotic withdrawal strategies are needed in order to reduce the overall prevalence of antipsychotic use.

Quetiapine for Borderline Personality Disorder

Study results on antipsychotic use in patients with borderline personality disorder have been conflicting, in part due to the many associated mood,

Treating the neuropsychiatric symptoms of dementia: A case based approach

INTRODUCTION It is estimated that about 90% of older adults with dementia experience neuropsychiatric symptoms. These symptoms include but are not limited to agitation, aggression, delusions, and hallucinations. Neuropsychiatric symptoms are often treated with antipsychotics. However, the use of antipsychotics in the dementia population is associated with an increased risk of death, mostly due to cerebrovascular events. All antipsychotic medications (both first generation and second generation) have a Black Box Warning for increased mortality in elderly patients with dementiarelated psychosis.

Antipsychotic treatment in breast cancer patients.

Special consideration is required when prescribing antipsychotic drugs for patients with an existing diagnosis of breast cancer. The package inserts of all approved antipsychotics contain precautions regarding their administration in this patient group. These drugs are well known to elevate serum prolactin levels to varying degrees. Overexpression of the prolactin receptor is seen in more than 95% of human breast cancers. Many genes that are activated by the prolactin receptor are associated with tumorigenesis and cancer cell proliferation. The authors discuss the pathophysiology, clinical implications, and pertinent preclinical data and make specific recommendations regarding the use of antipsychotics in patients with breast cancer.

Citalopram in Agitated and Delusional Demented Patients Who Failed Treatment With Antipsychotic Agents

Back to table of contents Previous article Next article DepartmentsFull AccessCitalopram in Agitated and Delusional Demented Patients Who Failed Treatment With Antipsychotic AgentsNabil Kotbi, M.D., Arun Singh, D.O., Jerard Kneifati-Hayek, B.A., Anna Odom, Ph.D., and George Alexopoulos, M.D.Nabil KotbiSearch for more papers by this author, M.D., Arun SinghSearch for more papers by this author, D.O., Jerard Kneifati-HayekSearch for more papers by this author, B.A., Anna OdomSearch for more papers by this author, Ph.D., and George AlexopoulosSearch for more papers by this author, M.D.Published Online:1 Apr 2014https://doi.org/10.1176/appi.neuropsych.13060122AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Agitation is a common, difficult to treat complication of dementing disorders. Optimal management of agitation consists of treatment of precipitants of agitation, including undiagnosed medical problems, pain, drug toxicity, environmental triggers, poor sleep, delirium, and depression.1 When precipitants of agitation are either absent or successfully treated, pharmacological treatment may target the syndrome of agitation. Antipsychotic agents are recommended as the first line treatment for this purpose. However, antipsychotic drugs have modest efficacy2 and entail safety concerns including orthostasis, drowsiness, extrapyramidal syndromes, incoordination, metabolic syndrome, prolonged QTc in EKG, and cerebrovascular events.3Antidepressants have received limited attention in the treatment of agitation of dementia. A controlled trial of demented patients psychiatrically hospitalized for agitation showed that citalopram and perphenazine were superior to placebo and found no difference in the efficacy of the two psychotropic agents.4 A more recent study showed that citalopram had equal efficacy with risperidone in demented patients who required psychiatric inpatient care because of agitation.5We recently successfully treated with citalopram two agitated, delusional, nondepressed, demented patients who had failed several trials of antipsychotics. Our first patient was an 84-year-old woman with a mixed Alzheimer’s/vascular dementia who was acutely hospitalized because of physical aggression and the somatic delusion that her organs were being moved around in her body. Trials of risperidone, haloperidol, and quetiapine led to equivalent response, while lorazepam worsened her agitation. On admission, risperidone was replaced with citalopram 10 mg twice daily and increased to 15 mg twice daily. Within 72 hours, the agitation diminished dramatically, and the patient was discharged soon thereafter. On follow-up several weeks after discharge, we found that she remained in good behavioral control.The second patient was an 80-year-old woman with Alzheimer’s dementia who presented with violent behavior and paranoia. She had failed trials of atypical and typical antipsychotics. She was initially treated with risperidone but showed no improvement. She was switched to citalopram 10 mg twice daily, which was later increased to 15 mg twice daily. Her agitation and paranoia improved 4 days after starting citalopram and remained agitation free throughout the hospitalization and several weeks after discharge.What is interesting about the above cases is that citalopram reduced agitation in nondepressed, demented patients with delusions and paranoia. Combined with earlier studies, this observation suggests that citalopram may be a reasonable treatment option for nondepressed, delusional, agitated, demented patients that do not share the side effects of antipsychotic agents.Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NYSend correspondence to Dr. Odom; e-mail: [email protected]cornell.eduDr. Alexopoulos has received grant support from Forest; he has served as a consultant to Forest, Hoffman-La Roche, Janssen, Lilly, Lundbeck, Pfizer, and Otsuka; and he currently serves or has served on the speakers' bureau of AstraZeneca, Avanir, Forest, Merck, Novartis, Sunovion, and Takeda-Lundbeck. All other authors report no financial relationships with commercial interests.References1 Salzman C, Jeste DV, Meyer RE, et al.: Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. J Clin Psychiatry 2008; 69:889–898Crossref, Medline, Google Scholar2 Sink KM, Holden KF, Yaffe K: Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005; 293:596–608Crossref, Medline, Google Scholar3 Steinberg M, Lyketsos CG: Atypical antipsychotic use in patients with dementia: managing safety concerns. Am J Psychiatry 2012; 169:900–906Crossref, Medline, Google Scholar4 Pollock BG, Mulsant BH, Rosen J, et al.: Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. Am J Psychiatry 2002; 159:460–465Crossref, Medline, Google Scholar5 Pollock BG, Mulsant BH, Rosen J, et al.: A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geriatr Psychiatry 2007; 15:942–952Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByLorazepam19 July 2014 | Reactions Weekly, Vol. 1510, No. 1 Volume 26Issue 2 Spring 2014Pages E62-E62 Metrics PDF download History Published online 1 April 2014 Published in print 1 April 2014

Variability between nursing homes in prevalence of antipsychotic use in patients with dementia

Antipsychotic drugs (APD) are widely prescribed for people with dementia residing in long term care facilities (LTCFs). Concern has been expressed that such prescribing is largely inappropriate. The objective of this study is to examine if differences in facility-level prevalence of APD use in a sample of LTCFs for patients with dementia can be explained by patient and facility-related characteristics. A point prevalence study was conducted using data from the VU University Resident Assessment Instrument (VURAI) database from nursing homes and residential care facilities in the Netherlands. Patients were selected who had a diagnosis of dementia. LTCF and patient characteristics were extracted from the VURAI; facility-level resident satisfaction surveys were provided by the National Institute for Public Health. In total, 20 LTCFs providing care for 1,090 patients with dementia were investigated. Overall, 31% of patients used an APD. In facilities with a high prevalence of APD use behavioral symptoms were present in 62% of their patients. In facilities with medium APD use behavioral problems remained frequent (57%), and in facilities with low prevalence of APD use 54% of the patients had behavioral symptoms. Facilities with a high prevalence of APD use were often large, situated in urban communities, and scored below average on staffing, personal care, and recreational activities. There was considerable variation between the participating LTCFs in the prevalence of APD use. Variability was related to LTCF characteristics and patient satisfaction. This indicates potential inappropriate prescribing because of differences in institutional prescribing culture.

Association Between Early-Onset Parkinson Disease and 22q11.2 Deletion Syndrome

Clinical case reports of parkinsonism co-occurring with hemizygous 22q11.2 deletions and the associated multisystem syndrome, 22q11.2 deletion syndrome (22q11.2DS), suggest that 22q11.2 deletions may lead to increased risk of early-onset Parkinson disease (PD). The frequency of PD and its neuropathological presentation remain unknown in this common genetic condition. To evaluate a possible association between 22q11.2 deletions and PD. An observational study of the occurrence of PD in the world's largest cohort of well-characterized adults with a molecularly confirmed diagnosis of 22q11.2DS (n = 159 [6 with postmortem tissue]; age range, 18.1-68.6 years) was conducted in Toronto, Ontario, Canada. Rare postmortem brain tissue from individuals with 22q11.2DS and a clinical history of PD was investigated for neurodegenerative changes and compared with that from individuals with no history of a movement disorder. A clinical diagnosis of PD made by a neurologist and neuropathological features of PD. RESULTS Adults with 22q11.2DS had a significantly elevated occurrence of PD compared with standard population estimates (standardized morbidity ratio = 69.7; 95% CI, 19.0-178.5). All cases showed early onset and typical PD symptom pattern, treatment response, and course. All were negative for family history of PD and known pathogenic PD-related mutations. The common use of antipsychotics in patients with 22q11.2DS to manage associated psychiatric symptoms delayed diagnosis of PD by up to 10 years. Postmortem brain tissue revealed classic loss of midbrain dopaminergic neurons in all 3 postmortem 22q11.2DS-PD cases. Typical α-synuclein-positive Lewy bodies were present in the expected distribution in 2 cases but absent in another. These findings suggest that 22q11.2 deletions represent a novel genetic risk factor for early-onset PD with variable neuropathological presentation reminiscent of LRRK2-associated PD neuropathology. Individuals with early-onset PD and classic features of 22q11.2DS should be considered for genetic testing, and those with a known 22q11.2 deletion should be monitored for the development of parkinsonian symptoms. Molecular studies of the implicated genes, including DGCR8, may help shed light on the underlying pathophysiology of PD in 22q11.2DS and idiopathic PD.

Dosage and duration of antipsychotic treatment in demented outpatients with agitation or psychosis.

The USA Food and Drug Administration (FDA) issued warnings regarding the use of antipsychotics in patients with dementia in 2003 and 2005. We aimed to study the dose and duration of antipsychotic treatment in dementia, and to examine whether physicians' prescription behaviors changed after the FDA warnings. Medical charts of outpatients who had Alzheimer's disease, vascular dementia, or mixed dementia were reviewed. Patients must have achieved a clinically stable state for at least 4 weeks after receiving antipsychotic treatment for agitation or psychosis. Demographics, clinical correlates, and duration of antipsychotic treatment were compared among different antipsychotic groups. Because the quetiapine group had the largest sample size, the optimal dose and duration of quetiapine treatment were compared among three time periods (before 2003, 2003-2005, after 2005). Stable state was achieved in 215 patients (80 had Alzheimer's disease, 117 vascular dementia, and 18 mixed dementia). Most patients (177) took quetiapine, 25 took risperidone, and 13 took sulpiride. The whole sample had a long total duration of antipsychotic treatment (median 525 days, mean 707 days). The median dose and total duration of antipsychotic treatment were 1.0mg/day and 238 days for risperidone, 100mg/day and 390 days for sulpiride, and 25mg/day and 611 days for quetiapine, respectively. The optimal dose and total duration of quetiapine treatment decreased significantly after FDA warning in 2005, although the duration remained long. The optimal doses of antipsychotics were not higher than those of western reports, but the total duration of antipsychotic treatment was quite long. Although our study suggests the prescription dosage and duration of antipsychotic treatment decreased significantly after FDA warning in 2005, the duration of treatment was still long. Given the serious safety concerns, more effort should be made to avoid unnecessary and prolonged prescription.

Sulpiride and refractory panic disorder

Dear Editor, The use of antipsychotics in patients with anxiety in recent years has increased, with a recent study showing that over a 12-year period, antipsychotic prescriptions in visits for anxiety disorders increased from 10.6 to 21.3 %, with the biggest increase among panic disorder (PD) patients (from 8 to 21.3 %) (Comer et al. 2011). Reasons for this remain unclear, but possible explanations include changes in patient characteristics, including increasing severity of illnesses among outpatient clients; greater prevalence or recognition of comorbidities (Comer et al. 2011); greater physician emphasis on symptom reduction, with increased acceptance of off-label antipsychotic prescriptions; a possible extrapolation to anxiety subjects by psychiatrists from their clinical experience of treating depressed patients with antipsychotics (Berman et al. 2009); and the availability of new antipsychotics with better side effect profiles, leading to a trend of changing from typical to atypical antipsychotics (Crystal et al. 2009). Also, contributing to this scenario could have been the fact that even with well-established treatment options, nearly 20 % of PD patients will remain substantially ill despite the use of the usual antipanic medication (Holt and Lydiard 2007). Furthermore, there is increasing evidence for the role of dopamine in fear and anxiety, through its modulation as a cortical brake that themedial prefrontal cortex exerts on the anxiogenic output of the amygdala, influencing the trafficking of impulses between the basolateral and central nuclei of the amygdala (de la Mora et al. 2010). Sulpiride is an antipsychotic of the benzamide type, structurally similar to amisulpride, and is used to treat schizophrenia, as well as depressive symptoms (Ruther et al. 1999). Also, anxiolytic-like effects of this drug have been reported in the elevated plus-maze test (Rodgers et al. 1994) and stress-induced freezing behavior in rats (Cavazzuti et al. 1999), in punished drinking behavior (Pich and Samanin 1986), and the mouse hyperdefensiveness test (PuglisiAllegra and Cabib 1988), suggesting a probable role in treatment of anxiety disorders, even as monotherapy. It is an antagonist of D2/D3 receptors, with almost no affinity for other receptors (Miyamoto et al. 2005), representing a good option in studies targeting effects on dopaminergic transmission. The aim of this study was to investigate the effects of 8 weeks of treatment with sulpiride on anxiety symptoms in a population with refractory PD. An open label challenge with sulpiride was conducted with 19 subjects (8 males and 11 females), aged 22 to 58 (mean age, 37.4 years). All patients were recruited from the outpatient clinic of Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro, in its Panic and Respiration Laboratory after a structured clinical interview (The Mini International Neuropsychiatric Interview) (Sheehan et al. 1998) and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for PD with agoraphobia. The subjects had no other E. A. Nunes (*) : J. A. S. Crippa : J. E. C. Hallak Department of Neuroscience and Behavior, Ribeirao Preto Medical School, University of Sao Paulo, National Institute for Translational Medicine (INCT-TM), Av. Bandeirantes, 3900, Monte Alegre S/N, Hospital das Clinicas 3o andar, Ribeirao Preto, SP, Brazil 14048-900 e-mail: emerson_arcoverde@yahoo.com.br

Use of antipsychotic medications in patients with Parkinson's disease at Auckland City Hospital

The American Academy of Neurology considers clozapine first line treatment for psychosis in Parkinson's disease (PD). In practice, patients are typically treated with quetiapine initially despite only level C evidence for use due to concern about side-effects, and changed to clozapine if they fail this. To review the use of antipsychotics in patients with PD and the demographics of PD patients who develop psychosis. Patients with PD on antipsychotic medications were identified by the Movement Disorder Nurse Specialist database and by reviewing patients admitted to Auckland City Hospital from January 2006 until March 2008. The demographic data, details of PD and antipsychotic use and comorbidities were recorded. Sixty-six patients with PD on antipsychotics were identified. The mean age was 75 years and 48 (73%) were in residential care. Patients admitted on antipsychotics had longer disease duration (P < 0.001) and were more likely to have cognitive impairment (P= 0.02) than those admitted not on antipsychotics. The most common indication for use was hallucinations. Patients on clozapine were younger (P < 0.005) and had less comorbidity (P= 0.04) than those on quetiapine. Fifty per cent (6/12) of patients on clozapine had previously failed quetiapine. Quetiapine has a good efficacy rate with minimal side-effects. This study lends support to the assumption that quetiapine is a useful medication. However, clozapine also was well tolerated and could be considered for use more frequently than it is.

Strategies for the Treatment of Antipsychotic-Induced Sexual Dysfunction and/or Hyperprolactinemia Among Patients of the Schizophrenia Spectrum: A Review

There is limited evidence for the management of sexual dysfunction and/or hyperprolactinemia resulting from use of antipsychotics in patients with schizophrenia and spectrum. The aim of this study was to review and describe the strategies for the treatment of antipsychotic-induced sexual dysfunctions and/or hyperprolactinemia. The research was carried out through Medline/PubMed, Cochrane, Lilacs, Embase, and PsycINFO, and it included open labels or randomized clinical trials. The authors found 31 studies: 25 open-label noncontrolled studies and 6 randomized controlled clinical trials. The randomized, double-blind controlled studies that were conducted with adjunctive treatment that showed improvement of sexual dysfunction and/or decrease of prolactin levels were sildenafil and aripiprazole. The medication selegiline and cyproheptadine did not improve sexual function. The switch to quetiapine was demonstrated in 2 randomized controlled studies: 1 showed improvement in the primary outcome and the other did not. This reviewed data have suggested that further well-designed randomized controlled trials are needed to provide evidence for the effects of different strategies to manage sexual dysfunction and/or hyperprolactinaemia resulting from antipsychotics. These trials are necessary in order to have a better compliance and reduce the distress among patients with schizophrenia.

The Antipsychotic Discontinuation in Alzheimer Disease Trial: Clinical Rationale and Study Design

: Research studies on the effects of discontinuing antipsychotic medications in patients with dementia have not identified specific target symptoms or response to antipsychotics prior to discontinuation. The Antipsychotic Discontinuation in Alzheimer Disease (ADAD) trial addresses these issues in a randomized, double-blind, placebo-controlled, multicenter risperidone treatment and discontinuation trial. In Phase A, AD patients with psychosis or agitation receive open treatment with risperidone for 16 weeks. Responders are randomized, double-blind, to one of three arms in Phase B: 1) continuation risperidone for the next 32 weeks, 2) risperidone for the next 16 weeks followed by placebo for 16 weeks, or 3) placebo for the next 32 weeks. : Several design features provide unique strengths to this trial: identification of target symptoms and systematic open antipsychotic treatment with only responders randomized in the discontinuation trial, use of a single antipsychotic medication, two clinically relevant time-points for discontinuation to evaluate the impact of duration of treatment on relapse, exclusion of patients at increased risk of stroke, assessment of several affected symptom domains, and state-of-the-art approaches to assess relapse and handle dropout. : This study will provide clinically relevant data on the likelihood and time to relapse, and predictors of relapse, in patients switched from risperidone to placebo after response to risperidone treatment. Given the warnings about antipsychotic use in patients with dementia, studies of this type are essential to determine the optimal duration of treatment that confers the greatest benefit to risk ratio and to improve evidence-based treatment strategies.

P-1100 - Pattern of antipsychotic use and its determinants in iran

Antipsychotic monotherapy is recognized as the treatment of choice for patients with psychosis but concurrent use is increasingly common among both inpatients and outpatients. Previous studies of the prescription patterns of psychotropic medications in psychotic patients have highlighted a high rate of antipsychotic polypharmacy, but data in Iran are sparse. This study seeks to analyze prescribing patterns of antipsychotic use and to estimate associated risks in this patient group. The aim of this study was to investigate the prevalence and its determinants of Antipsychotic Use in patients with psychiatric disorders in the greatest psychiatric hospital (Razi) in Iran. This study was on patients with psychiatric disorder that have discharged from the hospital during four months. We have assessed all patients with psychiatric interview and evaluation of their psychiatric documentations. Results of this study indicated that the most prevalent of psychiatric diagnosis was schizophrenia (33.42%) and then Bipolar I Disorder, Schizoaffective Disorder, Mental Retardation and Amphetamine-Induced Psychotic Disorder. 90.7% of all of patients had taken antipsychotic medications and antipsychotic polypharmacy was in 27.2% of these patients. The most prevalent component of antipsychotic polypharmacy was consisting of Chlorpromazine, Halopreidol and Chlorpromazine, Risperidone and then Chlorpromazine, Olanzapine respectively. There were significant relations between pattern of antipsychotic use and gender, occupation status, type of psychiatric ward, duration of hospitalization and cost of treatment but no relationship with age, educational status and duration of illness. This study suggests that prevalence of antipsychotic polypharmacy is high in in-patient psychiatric patients.