Clinical Queries: Atypical Antipsychotics in the Elderly

Project Lead

• Dr. Lara Cooke, Associate Dean, Continuing Education and Professional Development, University of Calgary

• Dr. Chris Symonds, Medical Director, Physician Learning Program, University of Calgary

Data Lead

• Alberta Health

Intended Outcomes

this project provides physicians with provincial prescribing trends of atypical antipsychotics in seniors and a snapshot of how many of their senior patients are receiving atypical antipsychotics. Clinical Pearls and links to evidence-informed prescribing support may help physicians reflect on their own practice data to optimize patient outcomes.

An article from our lead physician, Tamara Pringsheim, on the Atypical Antipsychotics project.

http://www.cmajopen.ca/content/2/4/E225.full.pdf+html

Schneider, L. S., Tariot, P. N., Dagerman, K. S., Davis, S. M., Hsiao, J. K., Ismail, M. S., … Lieberman, J. A. (2006). Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease. New England Journal of Medicine, 355(15), 1525–1538.

Full-text: http://www.nejm.org/doi/full/10.1056/NEJMoa061240#t=article

Ballard, C., & Waite, J. (2006). The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. The Cochrane Database of Systematic Reviews, (1), CD003476.

http://www.ncbi.nlm.nih.gov/pubmed/16437455

Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J.-H., Ewing, B., … Shekelle, P. G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA: The Journal of the American Medical Association, 306(12), 1359–1369.

Full-text: http://jama.jamanetwork.com/article.aspx?articleid=1104423

Flaherty, J. H., Gonzales, J. P., & Dong, B. (2011). Antipsychotics in the treatment of delirium in older hospitalized adults: a systematic review. Journal of the American Geriatrics Society, 59 Suppl 2, S269–276.

http://www.ncbi.nlm.nih.gov/pubmed/22091572

Sink, K. M., Holden, K. F., & Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA: The Journal of the American Medical Association, 293(5), 596–608.

Full-text: http://jama.jamanetwork.com/article.aspx?articleid=200265

Gill, S. S., Bronskill, S. E., Normand, S.-L. T., Anderson, G. M., Sykora, K., Lam, K., … Rochon, P. A. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146(11), 775–786.

http://www.ncbi.nlm.nih.gov/pubmed/17548409

Rochon, P. A., Normand, S.-L., Gomes, T., Gill, S. S., Anderson, G. M., Melo, M., … Gurwitz, J. H. (2008). Antipsychotic therapy and short-term serious events in older adults with dementia. Archives of Internal Medicine, 168(10), 1090–1096.

Full-text: http://archinte.jamanetwork.com/article.aspx?articleid=414239

U.S. Food and Drug Administration, U.S. Department of Health and Human Services. (2005). FDA public health advisory: deaths with antipsychotics in elderly Patients with behavioral disturbances Full-text: http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/drugsafetyinformationforheathcareprofessionals/publichealthadvisories/ucm053171.htm