Neuroleptics under High Risk Conditions*

1983 ◽  
Vol 28 (5) ◽  
pp. 398-403 ◽  
Author(s):  
L. K. Oyewumi
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Sexual Dysfunction ◽  
Elderly Patients ◽  
Tardive Dyskinesia ◽  
Psychiatric Patients ◽  
The Elderly ◽  
Child Bearing ◽  
Nursing Mothers ◽  
Suicidal Patients

A critical review of various high risk situations in which neuroleptics could be used and have been used in clinical practice is presented. These high risk situations include: women of child bearing age (pregnant women, lactating and/or nursing mothers), the two extremes of life (children and the elderly), patients with sexual dysfunction, patients with tardive dyskinesia, non-psychotic psychiatric patients, physically ill and suicidal patients. The extraordinary applications of these drugs, such as for rapid tranquilization and megadose regimens are examined. The author provides guidelines for the use of neuroleptics in these clinical situations.

scholarly journals Tapentadol Prolonged Release for Severe Chronic Osteoarthritis Pain in the Elderly—A Subgroup Analysis of Routine Clinical Practice Data

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Andreas Schwittay ◽  
Melanie Sohns ◽  
Birgit Heckes ◽  
Christian Elling
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Elderly Patients ◽  
Subgroup Analysis ◽  
The Elderly ◽  
Routine Clinical Practice ◽  
Prolonged Release ◽  
Younger Patients ◽  
Quality Of Life Measures

Background. Tapentadol prolonged release (PR) has been shown effective and generally well tolerated in a broad range of chronic pain conditions. This subgroup analysis investigated its benefits for elderly patients with severe chronic osteoarthritis (OA) pain in routine clinical practice. Patients and Methods. Data of all patients with chronic OA pain were extracted from the database of a prospective, 3-month noninterventional tapentadol PR trial. The data of elderly OA patients (>65 years of age; n = 752) were compared with the data of younger OA patients (≤65 years; n = 282). Results. Almost all patients (elderly 98.7% and younger patients 99.3%) had received long-term analgesic medication prior to the start of tapentadol PR treatment but presented with severe pain accompanied by considerable impairments in sleep quality and quality of life measures. Tapentadol PR provided effective pain relief in both patient groups, with slightly better outcomes in younger patients. However, the mean baseline pain intensity of 7.1 (SD 1.5) was reduced by 3.8 points (p≤0.001), and sleep and quality of life measures had also markedly improved in the elderly: quality of sleep by 3 points, quality of life by 3.4 points, social activities by 3 points, and independence by 2.7 points (p≤0.001 for all measures; 11-point scale). At the end of observation, 68% of the elderly had clinically relevant pain reductions of at least 50% (vs baseline), and 87.9% attained either their intended pain reduction target and/or an additional individual treatment target (both predefined during baseline examination). Only 8.4% of the elderly experienced adverse drug reactions, most frequently nausea (2.7% of patients) and dizziness (1.5%). Conclusion. Tapentadol PR provided effective and well-tolerated treatment of severe chronic OA pain for elderly patients in routine clinical practice. The favorable tolerability profile in particular suggests tapentadol PR as a treatment option before classical strong opioids are considered.

P1558Clinical utility of the PRECISE-DAPT score in the prediction of hemorrhagic events in elderly patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rioboo ◽  
E Abuassi Alnakeeb ◽  
S Raposeiras Roubin ◽  
I Munoz Pousa ◽  
M Cespon Fernandez ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Elderly Patients ◽  
Age Groups ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
The Elderly ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Risk Patients

Abstract Introduction The clinical utility and validity of the PRECISE-DAPT bleeding risk score for elderly patients with acute coronary syndrome (ACS) is unknown. We investigated the previous aspect in a contemporary population treated with percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT) at discharge. Methods Retrospectively, from 2010 to 2016, we studied 3,814 consecutive patients with the diagnosis of ACS. All patients were treated with in-hospital PCI and DAPT at discharge. Elderly was defined if patients aged ≥75 years. Patients were categorized into three risk strata according to their PRECISE-DAPT score (very low-low: <17 points, moderate: 18–24 points, and high risk: ≥25 points). We included the first bleeding event occurred during the first year after discharge. Bleeding events were defined according to the BARC classification system, and divided into two subgroups: BARC 2–5 and BARC 3–5. The ability to separate high bleeding risk patients from lower bleeding risk patients was checked by the cumulative incidence function curves and compared using the Fine-Gray test, thus adjusting for death (non-bleeding related) as a competing risk. Discrimination (C statistic) and calibration (Hosmer-Lemeshow test) were used to test the predictive capacity of the score in pts aged ≥75 years and <75 years. Results 25.2% (n=961/3814) were ≥75 years old, 38.4% of them were women. DAPT duration was 11.5 (interquartile range [IQR] 2.5–13.7) vs. 12.0 (RIQ 8.2–14.1) months in the elderly vs. younger; (p<0.001). 92.5% (n=889) of the elderly were at high risk of bleeding (PRECISE-DAPT≥25 points), compared to 21.3% (n=607) of the youngest. The incidence of BARC 2–5 and BARC 3–5 was 7.4% and 2.7% in the elderly compared to 5.1% and 1.4% among the younger patients (p<0.001). The figure shows the ability of the PRECISE-DAPT score at capturing the risk of BARC 2–5 bleeding (panel A and B), in both age groups. Using the cut-off point ≥25, the effect in the prediction of BARC 2–5 bleeding and BARC 3–5 did not differ significantly between the elderly and those <75 years: sHR = 1.9 (95% CI: 1.2–6.00) in the elderly vs. 1.8 (95% CI: 1.3–2.5) in the other group (p=0.99) and sHR = 3.3 (95% CI: 1.9–6.0) vs. 3.6 (95% CI: 1.9–6.7) (p=0.83), respectively. There were no significant differences between the elderly and those under 75 years in terms of statistical C values either for BARC 2–5 bleeding (0.60 vs. 0.58) or BARC 3–5 bleeding (0.64 vs. 0.67). The score performed well in term of calibration in both groups (all p-values >0.3). Conclusion Although the use of PRECISE-DAPT resulted in classifying the majority of elderly patients at high risk of bleeding and despite exhibiting modest discriminative power, it performed well at classifying patients according to their risk of 1-year out-of-hospital bleeding in both age groups. PRECISE-DAPT appears to identify the truly low risk patients among the elderly, as compared to the younger group.

scholarly journals Psychiatric Morbidity in Elderly Patients attending OPD of Lumbini Medical College and Teaching Hospital

2021 ◽  
Vol 9 (02) ◽  
pp. 36-40
Author(s):  
Bhaskkar Sharma ◽  
Rajesh Shrestha
Keyword(s):  
Depressive Disorder ◽  
Elderly Patients ◽  
Psychiatric Patients ◽  
Psychiatric Morbidity ◽  
The Elderly ◽  
Somatoform Disorder ◽  
Medical College ◽  
Common Diagnosis ◽  
Gender Specific Differences ◽  
And Gender

INTRODUCTION: Geriatric psychiatry patients are increasing but enough work has not been done in this area of Nepal. We conducted this study to find out the prevalence of different psychiatric morbidities in elderly population and to find out if there are any age and gender specific differences. MATERIAL AND METHODS: Medical records of psychiatric patients above 65 years of age visiting outpatient department of Lumbini Medical College and Teaching Hospitalfrom April 1, 2018 to March 31, 2019 were reviewed. Risks of having different psychiatric disorders was estimated using odds ratio. RESULTS: A total of 300 cases were enrolled in the study. Mean age of the study group was 71.49(SD=6.99). There were more females. Depressive disorderwas the most common diagnosis followed by somatoform disorder, anxiety disorder, dementia and others. Depressive disorder was higher in females and in younger subgroup of the elderly patient.The risk of having dementia was higher in older group. CONCLUSION: Depressive disorder was the most common psychiatric disorderfollowed by somatoform disorder in elderly patients above 65 years of age. Male patients were more likely to suffer psychiatric disorder as compared to females in this age.

Abstract TMP105: High Utilization Of CAS Procedures Among The Elderly In The Post Crest Era

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mahmoud Rayes ◽  
Pratik Bhattacharya ◽  
Rahul Damani ◽  
Seemant Chaturvedi
Keyword(s):  
High Risk ◽  
Elderly Patients ◽  
Medical Center ◽  
Significant Proportion ◽  
The Elderly ◽  
Carotid Revascularization ◽  
Choice Of Procedure ◽  
Asymptomatic Patients ◽  
Risk Criterion ◽  
Specific Symptoms

Background: An important interaction of age with outcome was revealed in Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) where elderly patients ≥70 years had worse outcomes with Carotid stenting (CAS) than with Endarterectomy (CEA). Our hypothesis was that following the CREST study, the proportion of CAS procedures in the elderly would decrease. Methods: We performed a retrospective review of carotid revascularization procedures between June 2009 and April 2012 at a large volume urban medical center. Demographics, indications, surgical high-risk criteria and outcomes of in-hospital stroke/death/MI were collected. Data analysis was performed in subjects over 70 years. Time trends were examined in the post-CREST period. Results: A total of 701 procedures (CEA 36%, CAS 64%) were performed during the study period, of which 360 (51.4%) were in patients ≥70 years (CEA 33%, CAS 67%). A significant proportion (22.1%) was in those ≥80 years. The choice of procedure did not change following CREST. The majority of CAS procedures in elderly (90.8%) were performed by cardiologists. Asymptomatic patients (47.3%) and patients with non-specific symptoms (18.7%) comprised a large proportion of this subgroup. A third of elderly patients with asymptomatic and nonspecific symptoms did not have any surgical high-risk criterion. The proportion of elderly patients receiving CAS for non-specific symptoms increased progressively over time post CREST (27.9% in the most recent months). A similar rise in non-specific indications was noted in the subgroup of patient ≥80 years receiving CAS. About half of this subgroup did not have any surgical high-risk criterion. Conclusion: Two years after CREST results, CAS continues to be performed among the elderly, often for non-specific symptoms or in asymptomatic patients. The lack of a decrease in CAS procedures in the elderly raises questions about whether evidence-based carotid revascularization occurs in the real world.

Tardive Dyskinesia: A Review

1995 ◽  
Vol 40 (7_suppl) ◽  
pp. 49-54 ◽  
Author(s):  
Paul R Latimer
Keyword(s):  
Clinical Practice ◽  
Tardive Dyskinesia ◽  
Antipsychotic Agent ◽  
Antipsychotic Agents ◽  
The Elderly ◽  
Research Findings ◽  
Chronic Neuroleptic ◽  
Novel Antipsychotic ◽  
Iatrogenic Disorder ◽  
Typical Neuroleptics

Objective: To review recent research findings on tardive dyskinesia (TD) with relevance to clinical practice. Method: TD is a syndrome of involuntary movements that can occur in association with chronic neuroleptic use. It is of unknown pathophysiology. It can be irreversible, is cosmetically disfiguring, and can be functionally disabling. Results: There is as yet no treatment of demonstrated efficacy for TD. It is an iatrogenic disorder whose incidence is increased by age and total cumulative dose of typical neuroleptics. It has been the source of successful litigation in some jurisdictions but, until very recently, there has been no effective antipsychotic agent without this effect. Conclusion: This litigation in some jurisdictions has been a major impetus to the development of novel antipsychotic agents. It is less well known that a similar, possibly identical, movement disorder occurs spontaneously particularly in the elderly and inpatients with schizophrenia, and that TD is often reversible.

Effect of Sodium Valproate on Tardive Dyskinesia

1976 ◽  
Vol 129 (2) ◽  
pp. 114-119 ◽  
Author(s):  
M. Linnoila ◽  
M. Viukari ◽  
O. Hietala
Keyword(s):  
Tardive Dyskinesia ◽  
Sodium Valproate ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
The Elderly ◽  
Elderly Subjects ◽  
Gamma Aminobutyric Acid ◽  
Double Blind ◽  
Psychiatric State ◽  
Chronic Psychiatric Patients

SummaryThe effect of sodium valproate, a drug which has been demonstrated to increase gamma-aminobutyric acid levels in the CNS, on tardive dyskinesia and psychiatric symptoms was investigated in a double-blind cross-over study on 32 chronic psychiatric patients. The oro-facial dyskinesias were totally or significantly relieved in 17 cases. During the active treatment period the involuntary movements of the extremities and dystonic spasms were also significantly relieved in 7 out of 9 patients. In two patients, however, the extrapyramidal symptoms became slightly worse. A significant improvement was noted in the psychiatric symptoms of 14 out of 32 patients during sodium valproate administration. The psychiatric state of 4 out of 32 patients deteriorated. There was no correlation between the serum concentration of sodium valproate and its effect on the dyskinesia or on the psychiatric symptoms. Some of the elderly subjects showed a slight accumulation of the drug.

scholarly journals Type 2 diabetes mellitus in elderly patients treated with endocrinologists in clinical practice

2020 ◽  
Vol 22 (6) ◽  
pp. 582-591
Author(s):  
Elena V. Biryukova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
High Risk ◽  
Elderly Patients ◽  
Large Scale ◽  
The Elderly ◽  
Modern Medicine ◽  
Aged Patients

A large-scale epidemic of type 2 diabetes mellitus (T2DM) is observed with advanced ageing worldwide. The prevalence of T2DM significantly increases with age. Therefore, this review aimed to summarise the data on T2DM in advanced and older aged patients. The primary geriatric syndromes, which should be considered for the management of older patients (cognitive impairment, sarcopenia, orthostatic hypotension, falls, urinary incontinence, senile asthenia, etc.), are presented. The causes of the high risk for hypoglycaemia in elderly patients are analysed. Improving the treatment for T2DM is a priority of modern medicine. Using antihyperglycaemic therapy is especially difficult in this population due to the high risk of hypoglycaemia and the multi-organ pathology leading to polypharmacy. Therefore, special attention is paid to treatment recommendations. Hypoglycaemic drugs used in elderly patients should be low risk of hypoglycaemia, without nephro- and hepatic toxicity, safe for cardiovascular organs, easy to administer. Furthermore, advantages and limitations of using various groups of hypoglycaemic drugs in elderly patients are discussed. DPP-4 inhibitors are also considered in detail. Modern data on mechanisms of hypoglycaemic action of DPP-4 inhibitors are presented. Possibilities of using sitagliptin in elderly patients were also considered. Finally, evidence-based studies demonstrating the obvious advantages of sitagliptin for the treatment of T2DM in the elderly and advanced aged population are discussed.

scholarly journals Research Progress of Nursing Care for Elderly Patients With Complicating Postoperative Hip Fracture Deep Vein Thrombosis in China

2021 ◽  
Vol 6 (4) ◽  
pp. 81
Author(s):  
Dandan Zheng ◽  
Wentao Cheng ◽  
Heyu Wu ◽  
Haichao Wu ◽  
Yuqi Cao
Keyword(s):  
Deep Vein Thrombosis ◽  
Hip Fracture ◽  
High Risk ◽  
Elderly Patients ◽  
The Elderly ◽  
Nursing Intervention ◽  
Psychological State ◽  
Research Progress ◽  
Vein Thrombosis ◽  
Deep Vein

Introduction: The aging of China's population has further deepened, and according to the results of the seventh national census, the population aged 60 years and above in China was 264.02 million, accounting for 18.70% (China.2021).The rapid growth of the elderly population has led to an increase a geriatric orthopedic morbidity. The hip fracture is one of the common orthopedic diseases, which has posed a severe threat to the elderly's life and health (Yu, 2019).Purpose: In this study, we investigated the domestic and international literature, focusing on the analysis of DVT nursing prevention programs for elderly patients after hip arthroplasty, and proposed the current nursing research progress in preventing DVT to help elderly patients actively cope with DVT, improve the quality of life in later life, and make DVT a truly preventable disease.Method: Electronic searches using scholarly databases were employed and only significant articles that met the review objective were utilized.Findings: Currently, the main treatment option for hip fracture patients in clinical practice is surgery, and how to prevent Deep Vein Thrombosis (DVT) is an important task in the postoperative care of elderly orthopedic patients (Li, 2016). Research studies have shown that all elderly patients are at a very high risk of DVT during hospitalization, but the current trend is that 50% of patients at high risk of thrombosis are still not actively and effectively prevented from developing thrombosis for various reasons.Conclusion: This disease, which has a high incidence, a high mortality rate, and is difficult to prevent, requires increased attention and necessitates exploration to derive effective nursing intervention programs and related nursing measures to prevent reduce the formation of DVT and alleviate suffering for patient (Xu, 2016).In this review, we summarized the main nursing methods for preventing deep vein thrombosis of the lower extremities after hip fracture surgery in the elderly. Elderly patients are a special group of people, both physically and psychologically in a relatively fragile state, especially after the operation, so they need to be more careful in nursing work. In addition to general physical care, the care of their psychological state is also extremely important. This article describes in detail the physiological and psychological nursing interventions for patients, which can effectively guide and help medical staff to cope with the clinical care of such patients, and enable patients to better recover from surgery and trauma, and obtain a good prognosis.

Azacitidine Plus Gemtuzumab Ozogamicin (GO): A Novel Combination in the Treatment of Acute Myeloid Leukemia (AML) and High-Risk Myelodysplastic Syndromes (MDS) in the Elderly.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1981-1981 ◽  
Author(s):  
Sucha Nand ◽  
John Godwin ◽  
Scott Smith ◽  
Kevin Barton ◽  
Eliza Germano ◽  
...  
Keyword(s):  
High Risk ◽  
Elderly Patients ◽  
Residual Disease ◽  
The Elderly ◽  
Gemtuzumab Ozogamicin ◽  
Outpatient Setting ◽  
Grade 3 ◽  
Wbc Count ◽  
Related Mortality

Abstract AML and high-risk MDS in the elderly carry a poor prognosis. Only 46% of AML patients receiving standard chemotherapy achieve complete remission (CR) and treatment-related mortality approaches 30% above age 60. In 2005, we initiated a Phase II trial for elderly patients with newly diagnosed AML or MDS, using the following outpatient treatment schema: If white blood cell (WBC) count at presentation was >10,000/ul, pt was started on hydroxyurea 1500 mg twice daily by mouth. Leukapheresis was performed if WBC >100,000/ul. Once WBC count was <10,000/ul, the patient received azacitidine 75 mg/m2 s/cu D1–7 and GO 3 mg/m2 on D8. A bone marrow was performed on D14 and induction therapy repeated for residual disease. Those who achieved CR were given one consolidation treatment with azacitidine+GO in same doses after recovery of blood counts. A total of 13 pts have been treated to date. Eleven had AML by WHO classification and 2 MDS (both RAEB). The median age was 77 (62–83) and 7 were male. Ten patients required retreatment on D14. Ten patients (76%) achieved CR. Six patients developed grade 3 toxicities: 5 neutropenic fever and 1 typhlitis, all requiring hospitalization. There were no treatment-related deaths. Median follow up is 7 months (2–13 months) and eleven patients remain alive. Two patients have died from relapsed or refractory disease. Nine patients remain in CR with a median duration of remission of 7 months (2–13 months). The trial is ongoing with an accrual goal of 20. Our early experience with this novel combination is quite encouraging. Cytoreduction with hydroxyurea and leukapheresis followed by azacitidine and GO appears to be a safe and effective regimen for elderly patients with AML and the therapy can be given in the outpatient setting. These preliminary results need to be confirmed in a larger cohort of patients.

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