Use of Antipsychotic Drugs in Dementia.ppt

Use of Antipsychotic Drugs in Dementia Josepha A. Cheong, MD University of Florida Departments of Psychiatry and Neurology Chief, Division of Geriatric Psychiatry What are common behavioral disturbances? Agitation Physical Verbal Resistiveness Mood Depression Anxiety What are common behavioral disturbances? Psychosis Disruption in the ability to differentiate real from unreal Hallucinations Illusions “Sundowning” Assessment Rule out any environmental disturbance change in home setting change in the staff/family members death of a pet Assessment R/o any possible medical illness urinary tract infection dehydration Assessment R/o drug-drug interactions or drug intolerance Assessment When does the behavior occur constant regardless of stimuli specific time of day with caregiving activity Assessment Endocrine Iatrogenic - consider non-prescription medications Injury Intoxication Treatment Behavioral Intervention Antidepressant medications Antipsychotic medications What is Psychosis? The state in which a person is unable to differentiate “real” from “unreal” Misperception of stimulus Hallucinations Illusions Delusions Agitation Antipsychotic Medications(doses adjusted for the geriatric age group) haloperidol (Haldol) .5 - 2.0mg risperidone (Risperdal) .5 - 6.0mg olanzapine (Zyprexa) 2.5 - 10.0mg ziprasidone (Geodon) 20-40mg quetiapine (Seroquel) 25mg - 300mg*** General Guidelines Monitor very carefully for side effects Monitor for benefit Consider decreasing the dose if symptoms improve Monitor for increased sedation and adjust the time of dosing FDA Warning – April 2005 Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances 15 out of 17 placebo-controlled trials showed numerical increases in mortality in the drug-treated group compared to the placebo-treated patients N = 5106 involving Risperidone (7 trials), Olanzapine (5 trials), Aripiprazole (3 trials) and Quetiapine (2 trials) ~1.6-1.7 fold increase in mortality in active treatment