Study Suggests Mortality Risk is High for Dementia Patients taking Antipsychotics

Posted on March 23, 2015 by southbaynami

From Psychiatric News Alert: Researchers from the University of Michigan Health System say that though antipsychotic medications are associated with increased mortality in older adults, little is known about such risk relative to no treatment or alternative psychotropic therapies.

Helen Kales, M.D., an associate professor of psychiatry and director of the Program for Positive Aging, and colleagues analyzed health records of more than 90,500 individuals aged 65 and older with dementia to access the risk for death in patients who received antipsychotics and those who did not. The researchers simplified the rate of risk for mortality by estimating how many elderly patients would have to be on a drug for one of them to die within six months, known as the “number needed to harm (NNH).”

The results, published this week in JAMA Psychiatry, showed that mortality risks statistically increased in patients taking antipsychotics to reduce symptoms of dementia, compared with individuals not being treated. Haloperidol was observed to be the riskiest—with one death per every 26 individuals taking the drug. Risperidone had a NNH of 27, followed by less risky olanzapine and quetiapine with NNHs of, respectively, 40 and 50. The researchers also observed the mortality risk for older adults with dementia who took antidepressants. The mortality risks were lower—with one person dying for every 166 individuals taking the medication.

“Our research indicates that antipsychotics may increase mortality more than previously realized. We hope this creates a dialogue about the advantages and disadvantages of antipsychotic and other psychotropic use as first-line treatment strategies for behavioral symptoms, which are universal and require effective treatments to address serious suffering among patients, families, and caregivers.”

Advantages of Long-Acting Injectable Antipsychotics

Posted on November 17, 2014 by southbaynami

With studies showing schizophrenia to be treatment refractory in one-fifth of those affected, psychiatrists are exploring other options to the delivery of effective treatment. At APA’s Institute on Psychiatric Services in San Francisco, some of the leading experts in psychopharmacology led a research symposium on the benefits of long-acting injectable (LAI) antipsychotic medications.Said Steven Potkin, M.D., director of clinical research at the University of California, Irvine:

“Psychiatrists who were trained during my time of training, think that long-acting injectable antipsychotics should be used for the most refractory, noncompliant, and difficult to treat patients. However, there is accumulating evidence that very early in the course of illness that this should be offered as an option, since half of the patients with first-episode psychosis discontinue medication after they are discharged from a hospital.”

Research on part of the “accumulating evidence” on long-acting injectable antipsychotics was presented by Keith Nuechterlein, Ph.D., a distinguished professor of psychiatry at the University of California, Los Angeles, who led a randomized study comparing LAI risperidone with oral rispiderone in 83 individuals who had a first psychotic episode within the two years prior to the study. The results showed that after one year of treatment, participants who received the daily oral form of risperidone had a 33%relapse rate, compared with 5% in those treated weekly with LAI risperidone. In addition, individuals in the oral risperidone cohort were four times more likely to be hospitalized than those taking the LAI version.

“We were struck that these were among the most dramatic results that have occurred for long-acting injectables—and it was in first-episode patients,” said Nuechterlein, adding that not only did patients experience advantages regarding outcomes associated with LAIs, but the patients accepted LAI medication quite readily. (The study was funded by the National Institutes of Health and Janssen Pharmaceuticals.)

“This symposium was an invitation for psychiatrists to rethink when is it appropriate to offer patients long-acting injectable medication. Should it be reserved only for refractory patients, or should it be offered to people earlier in the course [of illness]… or at any stage of illness? Of course, LAIs are not for everyone, but our patients should definitely be given options.”