PMID- 16970508
OWN - NLM
STAT- MEDLINE
DCOM- 20070109
LR  - 20181113
IS  - 0114-5916 (Print)
IS  - 0114-5916 (Linking)
VI  - 29
IP  - 10
DP  - 2006
TI  - Atypical antipsychotics for neuropsychiatric symptoms of dementia: malignant or 
      maligned?
PG  - 833-43
AB  - Recent concerns regarding the use of atypical antipsychotics when used for the 
      treatment of neuropsychiatric symptoms in dementia have led to a flurry of 
      studies attempting to re-evaluate their place in therapy. We critically review 
      current evidence on the safety profiles of these agents in patients with 
      behavioural and psychological symptoms of dementia (BPSD) and provide 
      recommendations to guide the clinician. Potential risks with this class of 
      medications include extrapyramidal symptoms (EPS), weight gain, diabetes 
      mellitus, cardiac conduction abnormalities (e.g. corrected QT [QTc] interval 
      prolongation), cerebrovascular adverse events and mortality. Compared with 
      placebo, treatment of BPSD with atypical antipsychotics leads to little or no 
      increase in EPS and no significant weight change. Compared with typical 
      antipsychotics, treatment of BPSD with atypical antipsychotics leads to a reduced 
      risk of EPS, lower incidences of tardive dyskinesias and no significant weight 
      gain. Atypical antipsychotics have not been associated with glucose intolerance, 
      diabetes or hyperlipidaemia in elderly dementia patients. Both typical and 
      atypical antipsychotics have been associated with cardiac conduction 
      abnormalities, with the magnitude of QTc prolongation being slightly smaller with 
      atypical antipsychotics. Randomised controlled trials suggest that atypical 
      antipsychotics are associated with an increased risk of cerebrovascular adverse 
      events, such as stroke, and an increased mortality compared with placebo. 
      However, it appears that typical antipsychotics have similar risks of 
      cerebrovascular adverse events and death. An increased risk of anticholinergic 
      adverse effects and falls must also be considered with both typical and atypical 
      antipsychotics. In summary, atypical antipsychotics are associated with 
      potentially serious adverse events. Before prescribing these medications in 
      elderly dementia patients, baseline EPS, ECG abnormalities and concomitant 
      medications should be assessed, and the presence of cardiovascular, 
      cerebrovascular and metabolic risk factors should be taken into consideration 
      when benefits and risks are being weighed.
FAU - Herrmann, Nathan
AU  - Herrmann N
AD  - Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences 
      Centre, Toronto, Ontario, Canada. n.herrmann@utoronto.ca
FAU - Lanctot, Krista L
AU  - Lanctot KL
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - New Zealand
TA  - Drug Saf
JT  - Drug safety
JID - 9002928
RN  - 0 (Antipsychotic Agents)
SB  - IM
MH  - Antipsychotic Agents/*adverse effects/*therapeutic use
MH  - Dementia/diagnosis/*drug therapy
MH  - Humans
RF  - 67
EDAT- 2006/09/15 09:00
MHDA- 2007/01/11 09:00
CRDT- 2006/09/15 09:00
PHST- 2006/09/15 09:00 [pubmed]
PHST- 2007/01/11 09:00 [medline]
PHST- 2006/09/15 09:00 [entrez]
AID - 29102 [pii]
AID - 10.2165/00002018-200629100-00002 [doi]
PST - ppublish
SO  - Drug Saf. 2006;29(10):833-43. doi: 10.2165/00002018-200629100-00002.