Antipsychotic Prescribing Practices Amongst the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S663-S663
Author(s):  
C. Power ◽  
B. McCarthy ◽  
B.A. Lawlor ◽  
E. Greene
Keyword(s):  
Best Practice ◽  
The Elderly ◽  
Medical Documentation ◽  
Psychotic Symptoms ◽  
Prescribing Practices ◽  
Next Of Kin ◽  
Pharmacological Interventions ◽  
Antipsychotic Medications ◽  
Number Of Patients ◽  
Antipsychotic Prescribing

IntroductionPsychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).ObjectivesTo examine antipsychotic prescribing practices in SJH.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.ResultsComplete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.ConclusionPositive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

Treatment of Depression

2017 ◽  
Author(s):  
Martin Steinberg
Keyword(s):  
Suicide Attempts ◽  
Antidepressant Treatment ◽  
Severe Depression ◽  
Poor Response ◽  
Psychosocial Interventions ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Pharmacological Interventions ◽  
Multiple Risk Factors ◽  
Treatment Of Depression

Most depression in the elderly can be effectively treated in the primary care setting. Psychiatric referral should be considered in the setting of severe depression, suicidal ideation, prior suicide attempts, multiple risk factors, psychotic symptoms, bipolar disorder, poor response to prior treatment, or high medical comorbidity. Combining pharmacological and psychosocial interventions is most likely to be effective. Available antidepressants include serotonin-specific reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, novel mechanism agents, tricyclic antidepressants, and monoamine oxidase inhibitors. Antidepressant selection should take into account adverse effects, medical comorbidities, potential medication interactions, and patient preferences. Additional strategies (e.g. augmentation) are available for treatment resistant depression. Available psychotherapies include supportive, cognitive-behavioral, interpersonal, and problem solving. Lifestyle interventions (e.g. exercise) may be helpful adjuncts. Given limited evidence for antidepressant treatment in cognitive impairment, for those with mild to moderate depression severity, non-pharmacological interventions should be attempted first.

Acute electroconvulsive therapy in the elderly with schizophrenia and schizoaffective disorder: a literature review

2019 ◽  
Vol 27 (5) ◽  
pp. 472-476 ◽  
Author(s):  
David Kumagaya ◽  
Graeme Halliday
Keyword(s):  
Elderly Patients ◽  
Electroconvulsive Therapy ◽  
Literature Search ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Medical Complications ◽  
Treatment Resistant ◽  
Antipsychotic Medications ◽  
Valuable Treatment ◽  
Almost All

Objectives: This study reviewed the evidence regarding the efficacy of acute electroconvulsive therapy for primary psychotic conditions in the elderly. Methods: A literature search was performed using the Medline, Embase and Cochrane databases. Results: Acute electroconvulsive therapy resulted in an improvement of psychotic symptoms in almost all elderly patients, a large proportion of whom had treatment-resistant conditions. No electroconvulsive therapy related fatalities or severe medical complications were encountered. Conclusions: Acute electroconvulsive therapy may present a valuable treatment modality for elderly patients with primary psychotic conditions who do not respond adequately to antipsychotic medications.

Cardiac Issues Raised by an Examination of the Antipsychotic Prescribing Practices in the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S659-S659
Author(s):  
B. McCarthy ◽  
C. Power ◽  
B. Lawlor ◽  
E. Greene
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Cardiac Risk ◽  
Antipsychotic Treatment ◽  
Qtc Interval ◽  
Prescribing Practices ◽  
Antipsychotic Medications ◽  
Average Change ◽  
Competing Interest ◽  
Current Monitoring

BackgroundAntipsychotic medication use may be associated with prolongation of the QTc interval, increasing the risk of potentially fatal arrhythmias [1]. This is particularly pertinent in the elderly due to comorbid cardiovascular disease and polypharmacy. Attention to the ECG and co-prescribed medications is essential to minimise cardiac risk when prescribing antipsychotics.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified as part of a hospital-wide survey. Data was collected from medical and electronic patient notes and medication kardexes.ResultsComplete data was obtained for 36 patients aged over 65 who were newly-prescribed an antipsychotic or had their antipsychotic changed. Of these, 39%(n = 13) had a cardiac history. One quarter did not have an ECG in the 12 months preceding antipsychotic initiation. Of the 28 patients with an ECG, 57% (n = 16) had a QTc > 450ms before starting antipsychotic treatment. Only 11% (n = 4) had an ECG within 24 hours of starting the antipsychotic. The average change of the QTc interval in those with a repeat ECG was 30msecs. 42% (n = 15) were co-prescribed another QTc-prolonging medication.ConclusionCurrent monitoring of QTc interval in an elderly population newly prescribed antipsychotic medications is inadequate and a cause for significant safety concerns. Education and clear guidance is warranted to improve safety and minimise risk in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments

2017 ◽  
Vol 11 (3) ◽  
pp. 270-275 ◽  
Author(s):  
Cecília Carboni Tardelli Cerveira ◽  
Cláudia Cristina Pupo ◽  
Sigrid De Sousa dos Santos ◽  
José Eduardo Mourão Santos
Keyword(s):  
Systematic Review ◽  
Cognitive Function ◽  
Remission Rate ◽  
Early Mobilization ◽  
The Elderly ◽  
Pharmacological Intervention ◽  
Pharmacological Treatments ◽  
Pharmacological Interventions ◽  
Number Of Patients ◽  
The Impact

ABSTRACT Delirium is a common disorder associated with poor prognosis, especially in the elderly. The impact of different treatment approaches for delirium on morbimortality and long-term welfare is not completely understood. OBJECTIVE: To determine the efficacy of pharmacological and non-pharmacological treatments in elderly patients with delirium. METHODS: This systematic review compared pharmacological and non-pharmacological treatments in patients over 60 years old with delirium. Databases used were: MEDLINE (PubMed), EMBASE, Cochrane CENTRAL and LILACS from inception to January 6th, 2016. RESULTS: A total of ten articles were selected. The six non-pharmacological intervention studies showed no impact on duration of delirium, mortality or institutionalization, but a decrease in severity of delirium and improvement in medium-term cognitive function were observed. The most commonly used interventions were temporal-spatial orientation, orientation to self and others, early mobilization and sleep hygiene. The four studies with pharmacological interventions found that rivastigmine reduced the duration of delirium, improved cognitive function and reduced caregiver burden; olanzapine and haloperidol decreased the severity of delirium; droperidol reduced length of hospitalization and improved delirium remission rate. CONCLUSION: Although the pharmacological approach has been used in the treatment of delirium among elderly, there have been few studies assessing its efficacy, involving a small number of patients. However, the improvements in delirium duration and severity suggest these drugs are effective in treating the condition. Once delirium has developed, non-pharmacological treatment seems less effective in controlling symptoms, and there is a lack of studies describing different non-pharmacological interventions.

scholarly journals Letter to the Editor: Microbiota in the Respiratory System—A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2

2021 ◽  
Vol 14 ◽  
pp. 117863612098860
Author(s):  
Vishal Shah
Keyword(s):  
Respiratory System ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Elderly Adult ◽  
Human Respiratory Tract ◽  
System A ◽  
Number Of Patients ◽  
Children And Young Adults ◽  
Age And Sex

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.

scholarly journals Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

2021 ◽  
Vol 10 (2) ◽  
pp. 308
Author(s):  
Angel L. Montejo ◽  
Rubén de Alarcón ◽  
Nieves Prieto ◽  
José Mª Acosta ◽  
Bárbara Buch ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Management Strategies ◽  
Drop Out ◽  
Adjunctive Treatment ◽  
Psychotic Symptoms ◽  
Clinical Approach ◽  
Clinical Perspective ◽  
Pharmacological Interventions ◽  
Dopaminergic Agonist ◽  
Low Rate

Antipsychotic medication can be often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) remains underestimated in clinical practice. However, psychotic patients consider sexual issues as important as first rank psychotic symptoms, and their disenchantment with TESD can lead to important patient distress and treatment drop-out. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antipsychotic with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: prescribing either aripiprazole or another dopaminergic agonist as a first option antipsychotic or switching to it whenever possible. Whenever this is not possible, adjunctive treatment with aripiprazole seems to also be beneficial for reducing TESD. Some antipsychotics, like olanzapine, quetiapine, or ziprasidone, have less impact on sexual function than others, so they are an optimal second choice. Finally, a variety of useful strategies (such as the addition of sildenafil) are also described where the previous ones cannot be applied, although they may not yield as optimal results.

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