PMID- 22928861
OWN - NLM
STAT- MEDLINE
DCOM- 20130606
LR  - 20130131
IS  - 1364-6915 (Electronic)
IS  - 1360-7863 (Linking)
VI  - 17
IP  - 1
DP  - 2013
TI  - The effects of abrupt antipsychotic discontinuation in cognitively impaired older 
      persons: a pilot study.
PG  - 125-32
LID - 10.1080/13607863.2012.717255 [doi]
AB  - BACKGROUND: Antipsychotic use for behavioural and psychological symptoms of 
      dementia (BPSD) is controversial. Guidelines advise to reduce antipsychotics 
      given the adverse effects and limited efficacy, to limit dose and treatment 
      duration as well as to undertake discontinuation. METHODS: A pilot study with 40 
      hospitalised geriatric cognitively impaired patients, in which the effects of 
      abrupt antipsychotic discontinuation were investigated, using neuropsychiatric 
      inventory (NPI) scores before and one month after discontinuation. Withdrawal 
      symptoms were monitored thrice a day with a checklist during five consecutive 
      days. RESULTS: Participants (n = 40) had a mean age of 84 years (range 67-95) and 
      53% were male. The total mean baseline NPI score was 21 (SD 12) with 
      predominantly behavioural rather than psychological disturbances. After abrupt 
      discontinuation, mild withdrawal symptoms were observed in 72% of the patients, 
      with frequencies of symptoms peaking on day 2 (53%) and day 3 (48%). After one 
      month, 31 patients (85%) were still off antipsychotics and improved on the 
      majority of NPI domains, with a total mean NPI score decreasing from 18 (SD 13) 
      to 12 (SD 8, p = 0.003). In the relapse group, there was no deterioration 
      associated with the abrupt discontinuation and subsequent resumption of therapy 
      with a total mean NPI score decreasing from 31 (SD 12) at baseline to 27 (SD 8) 
      at one-month follow-up (p = 0.345). CONCLUSION: Abrupt antipsychotic 
      discontinuation appears to be feasible in older individuals with BPSD. 
      Systematically performed discontinuation efforts in clinical practice are needed 
      to differentiate between patients where antipsychotics have no added value and 
      patients where the benefits outweigh the risks.
FAU - Azermai, M
AU  - Azermai M
AD  - Division of Clinical Pharmacology, Heymans Institute of Pharmacology, Ghent 
      University, Ghent, Belgium. majda.azermai@ugent.be
FAU - Petrovic, M
AU  - Petrovic M
FAU - Engelborghs, S
AU  - Engelborghs S
FAU - Elseviers, M M
AU  - Elseviers MM
FAU - Van der Mussele, S
AU  - Van der Mussele S
FAU - Debruyne, H
AU  - Debruyne H
FAU - Van Bortel, L
AU  - Van Bortel L
FAU - Vander Stichele, R H
AU  - Vander Stichele RH
LA  - eng
PT  - Journal Article
DEP - 20120828
PL  - England
TA  - Aging Ment Health
JT  - Aging & mental health
JID - 9705773
RN  - 0 (Antipsychotic Agents)
SB  - IM
MH  - Activities of Daily Living
MH  - Aged
MH  - Aged, 80 and over
MH  - Antipsychotic Agents/*adverse effects/therapeutic use
MH  - Dementia/*drug therapy/psychology
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Feasibility Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Neuropsychological Tests
MH  - Pilot Projects
MH  - Severity of Illness Index
MH  - *Substance Withdrawal Syndrome
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2012/08/30 06:00
MHDA- 2013/06/07 06:00
CRDT- 2012/08/30 06:00
PHST- 2012/08/30 06:00 [entrez]
PHST- 2012/08/30 06:00 [pubmed]
PHST- 2013/06/07 06:00 [medline]
AID - 10.1080/13607863.2012.717255 [doi]
PST - ppublish
SO  - Aging Ment Health. 2013;17(1):125-32. doi: 10.1080/13607863.2012.717255. Epub 
      2012 Aug 28.