Summary: The Use Of Antipsychotic Drugs On Geriatric Patients

Purpose: It has been well established that use of Antipsychotics (APs) and Benzodiazepines (BZDs) in the elderly population is associated with increased incidence of adverse effects including sedation, falls, and cognitive impairment. The Veterans Health Administration (VHA) introduced the Psychotropic Drug Safety Initiative (PDSI) to improve evidence-based psychotropic drug prescribing for Veterans with mental illness. This initiative aims to address possible issues with pharmacotherapy such as overprescribing, clinical management, and inappropriate indications.1 The purpose of this project is to assess the impact of recommendations made by a pharmacist on the utilization of APs and BZDs in patients with dementia.

Psychotropic medications are approved by the US Food and Drug Administration (FDA) primarily for the treatment of psychosis and mood disturbances associated with schizophrenia or bipolar disorders (Grunier, 2008). Despite FDA black box warnings related to the “off-label” use of these medications in the dementia population, a survey conducted by the Office of Inspector General in 2011 found that 86% to 95% of nursing home residents received these medications for other indications, such as managing behavioral disturbances associated with dementia (Chiu, 2015). It is the overuse and misuse of psychotropic medications, in particular as a strategy to subdue residents, that has designated these drugs to be labeled

Phillips states that individuals with dementia often display resistance to care, confusion, disruptive or aggressive behaviors: For these reasons, many seniors who are not actually suffering from psychosis are given antipsychotic medications. The goal of the pan-Canadian Reducing Antipsychotic Medication in Long Term Care program was to encourage long-term care facilities and nursing homes to discontinue the use of unnecessary antipsychotic medications to experiment with alternative therapies.

Regarding restraints it says, “The right to be free of physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraint imposed for purposes of discipline or convenience and not required to treat the residents’ medical symptoms.” (California Advocates for Nursing Home Reform, 2010). Despite this federal law against the use of psychotropic drugs as chemical restraints there are still an estimated 300,000 residents that have prescriptions written for these drugs to relieve anxiety or aggression (Jaffe, 2014). The lawyers at Paul and Perkins PA have published a nursing home abuse guide. According to this guide in 2005 the FDA mandated that a black box warning be placed on antipsychotics warning of an increased risk of mortality in dementia patients. It goes on to explain that that the longer the medication is administered; more is building up in the patients system. This accumulation puts the patient at an increased risk of heart attack and stroke. Another study that was conducted in 2007 brought out that 1 in 7 nursing home residents had Medicare claims for antipsychotic medication and out of that 1 in 7 83% of those orders for were prescribed for off label use (Smith, 2012). Meaning that these residents had no medical history of serious mental

As we have seen, treatment of schizophrenia with antipsychotic drugs can have impressive results in terms of decreasing active symptoms, although it does nothing to alleviate negative symptoms or to improve cognitive functioning. Unfortunately, this kind of treatment has the drawback of extremely serious and even fatal side-effects. Newer generation atypical antipsychotics offer more hope, as they can treat both active and negative symptoms, and also improve cognitive functioning. Moreover, they have fewer side-effects. However, treatment is complicated by the fact that results are unpredictable; and in addition the side-effects that they do have can be very serious, such as diabetes, which in itself is life-threatening. However, as the potential side-effects are known, the physician has leeway to choose a drug which is a good match for the patient’s clinical profile. Then, once the patient’s symptoms have been much alleviated with an appropriate newer generation atypical antipsychotic, the patient should be able to also benefit from a range of psychotherapeutic interventions. It is argued that this is the best treatment regime to choose, as it is likely to result in the greatest improvement in quality of life, coupled with the lowest risk of potentially devastating side-effects, or of death. This is likely to be better than utilizing cognitive behavioral therapy, the results of which are not reliably known – although research has certainly shown that it is less efficacious

2. The purpose of this study is to evaluate the efficacy and safety of low dose risperidone in treating psychosis of Alzheimer’s disease (AD) and mixed dementia (MD) in a subset of nursing-home residents who had dementia and aggression and who were participating in a randomized placebo-controlled trail of risperidone for aggression.

Cerebrovascular effects are also possible, however, a patients could bring this upon themselves if they become extremely agitated and heightened their blood pressure and heart rate past the normal range. Antipsychotic drugs help control this by keeping their moods much more constant, which keeps them from getting worked up and increasing their heart rate and blood pressure. Most dementia patients already have other health problems and by them not taking antipsychotics it could do more harm than good. Antipsychotic drugs are not for every dementia patient, but in some cases their quality of life can be greatly improved by the drug. It is ultimately the patient’s doctor’s and caregiver’s decision whether antipsychotics are the best form of treatment for them. I have personally seen the benefits in my great grandmother and believe the medications, when used the right way, can be very advantageous. She has advanced dementia and was put on the antipsychotic drug Xanax, which has greatly improved her quality of life. The downsides of the drug definitely do not outweigh the benefits it offers

In the early 1990s new antipsychotic medications were developed and used to help those dealing with bipolar and schizophrenia which have symptoms like psychosis and hallucinations. These medications are called second-generation or atypical antipsychotics and they are the first line

□ Patient is trained to learn to cope with stress and detect signs of relapse

Recently published study revealed that dementia patients who are taking antipsychotics drugs are more on risks of death. And the risk increased as dose increased. Patients, families and their care teams deserve better to prevent and treat distressing dementia symptoms. So it better to avoid this drug in dementia patient. When treating behavior problems in dementia patients, non-medicinal strategies are often more effective; however, they require time, energy, and,

Antipsychotics are classified as major tranquilizers that are used to treat mental health illnesses such as schizophrenia, bipolar disorder, and other mental illnesses. They can also treat severe depression and severe anxiety. These antipsychotics drugs reduce or increase the effect of neurotransmitters in the brain to regulate levels that help transfer information throughout the brain. The neurotransmitters that are affected are the serotonin, dopamine, and noradrenaline.

Most government controlled homes do not get sufficient funds, so they lack trained workers and necessary equipment. Still, they get more help and don’t prioritize money, which results in better quality service. “Chains and for-profit companies use a system of rewards and sanctions for managers and board of directors, executives must prioritize shareholder value which may compromise other goals such as quality” (Harrington 786). Another issue is that many nursing homes use antipsychotic drugs but often times they administer them illegally, harming the patients. It was found in a recent study that 41% of patients use antipsychotics for a long period of time. The push by pharmaceutical companies to market their products can sometimes be the reason

Guidelines14 suggest that in elderly patients, and in patients with mild to moderately agitation , haloperidol can be started at low doses—i.e., 0•5 mg (orally) twice to three times a day—and then be titrated to obtain an effect. Severe cases and younger patients need more haloperidol. In the severely agitated patient rapid dosing is needed. In this situation parenteral doses are recommended and haloperidol doses such as 1–2 mg in young patients and 0.25–0.5 mg in elderly patients (≥60 years), repeated after 1–2 h are given until agitation resolves. Protocols for rapid titration are available.15 Haloperidol is the least sedating of the antipsychotics and can be given intravenously and by mouth. 16The atypical antipsychotics are useful as they have less propensity for EPS and less potential for effects on cardiac conduction.17 The atypical antipsychotics are not able to be given by the parenteral route. Commonly used atypical antipsychotics include olanzapine, quetiapine and risperidone. The atypical antipsychotics are also ideal for the patient with underlying Parkinson’s disease. Benzodiazepines are not indicated for management of delirium and are best used in setting of delirium associated with alcohol

Ballard and Waite (2006) report that there is no evidence to support the efficacy of antipsychotic medication for treating dementia-related psychosis and behavioural problems. A recent study by Ballard et al (2009) indicates that there is an increased long-term risk of mortality in patients with Alzheimer’s disease who are prescribed

Dementia is a group of symptoms caused by other disorders that affect a person’s cognition, it affects short and long-term memory that results in impaired judgment, personality changes and problem solving abilities (Wagner, Johnson & Kidd, 2013). Changes in personality and judgement can lead to agitation and aggression in these patients. One of the reasons patients present in health care facilities is related to the caregiver being unable to handle these type of behaviors (Ballard, Corbett, Chitramohan, Aarsland, 2009). The focus of this study is the use of antiepileptic drugs (AED’s) also called anticonvulsant medications in patients that have dementia with aggression and agitation living in health care facilities.