scholarly journals A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults

2019 ◽  
Vol 9 (4) ◽  
pp. 280-286 ◽  
Author(s):  
Jamie L. McCarrell ◽  
Trista A. Bailey ◽  
Nakia A. Duncan ◽  
Les P. Covington ◽  
Kalin M. Clifford ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trials ◽  
Psychological Symptoms ◽  
Neuropsychiatric Disorders ◽  
Adverse Outcomes ◽  
Qtc Interval ◽  
Cardiac Outcomes ◽  
Pubmed Database ◽  
Anxiety Depression ◽  
Behavioral And Psychological Symptoms

Abstract Introduction Neuropsychiatric disorders affect millions of older adults. Despite this, there are relatively few older adults included in clinical trials evaluating treatments for psychiatric disorders. Citalopram has been evaluated in older adults with neuropsychiatric disorders and has largely been found beneficial, making the 2011 US Food and Drug Administration (FDA) safety advisory on citalopram extremely impactful. Methods A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English. Results Review of the literature confirms the efficacy of citalopram in depression, anxiety, depression associated with Parkinson disease, and behavioral and psychological symptoms of dementia. Additionally, no adverse cardiac outcomes have been described related to citalopram. Discussion The FDA's evidence for applying this safety advisory to citalopram is minimal and largely based on surrogate markers, such as the QTc interval rather than clinical and safety outcomes. Citalopram is known to increase the QTc, but this increase has not been linked to adverse cardiac outcomes. The evidence for efficacy and against adverse outcomes suggests that a reevaluation of the dosing restrictions in older adults with neuropsychiatric disorders is needed.

scholarly journals Neuropsychiatry of Parkinson's disease

2009 ◽  
Vol 67 (3b) ◽  
pp. 930-939 ◽  
Author(s):  
Arthur Kummer ◽  
Antonio Lucio Teixeira
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Impulse Control ◽  
Psychological Symptoms ◽  
Current Knowledge ◽  
Psychological Mechanisms ◽  
Anxiety Depression ◽  
Non Motor Symptoms ◽  
Behavioral And Psychological Symptoms ◽  
Significant Factors

Parkinson's disease (PD) is traditionally regarded as a movement disorder. In recent years, however, non-motor symptoms have been considered significant factors of disability at all stages of the illness. Behavioral and psychological symptoms or neuropsychiatric syndromes associated with PD are frequent and may represent a challenge in the management of these patients. They include anxiety, depression, psychosis, sleep, sexual and impulse control disorders, apathy and cognitive dysfunction. Their pathogenesis in PD is complex, involving neurodegenerative, drug-related and psychological mechanisms. We will review the current knowledge of this growing field, also focusing on the management of theses syndromes.

Caregiver-Reported Sleep Disturbances Are Associated With Behavioral and Psychological Symptoms in an Asian Elderly Cohort With Cognitive Impairment-No Dementia

2018 ◽  
Vol 31 (2) ◽  
pp. 70-75
Author(s):  
Xin Xu ◽  
Cheuk Ni Kan ◽  
Tien Yin Wong ◽  
Ching-Yu Cheng ◽  
M. Kamran Ikram ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sleep Disturbances ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Risk Of Progression ◽  
Elderly Cohort ◽  
Anxiety Depression ◽  
Behavioral And Psychological Symptoms ◽  
Asian Sample ◽  
Cognitive Impairment No Dementia

Objective: Sleep disturbances were found to be associated with more behavioral and psychological symptoms (BPS) in early patients with Alzheimer's disease (AD). However, data on preclinical stages of dementia are lacking. Hence, the present study sought to investigate the association between sleep disturbances and BPS in dementia-free elderly with varying severity of cognitive impairment in an Asian sample. Methods: Community-living elderly were recruited and administered a comprehensive cognitive battery (vascular dementia battery [VDB]) and the Neuropsychiatric Inventory to assess symptoms of sleep disturbances and BPS. Severity of cognitive impairment was diagnosed and classified as no cognitive impairment (NCI), cognitive impairment-no dementia (CIND) -mild (1-2 impaired domains on the VDB), and CIND-moderate (≥3 impaired domains on the VDB). Analysis of variance was conducted to assess the associations between the presence of sleep disturbances and BPS scores in each diagnostic group. Logistic regression was used to examine whether the coexistence of sleep disturbances and other BPS was associated with CIND-moderate, which is known to carry a higher risk of progression to AD. Results: Among 839 elderly, 79 (9.4%) reported sleep disturbances. Participants with sleep disturbances had higher total BPS burden than those without among CIND participants but not in NCIs. Furthermore, CIND-moderate participants with sleep disturbances had more delusions, hallucinations, anxiety, depression, irritability, aberrant motor behavior, and appetite change ( P < .05). The presence of both sleep disturbances and other BPS was associated with CIND-moderate (odds ratio: 2.5, 95% confidence interval: 1.1-5.5). Conclusions: Sleep disturbances are associated with higher total BPS burden and specific BPS among elderly patients with cognitive impairment, particularly those with CIND moderate, which carries higher risk of developing dementia.

scholarly journals Randomized controlled trial of mibampator for behavioral and psychological symptoms of dementia: comments on the trial and thoughts for future studies

2013 ◽  
Vol 25 (5) ◽  
pp. 687-689 ◽  
Author(s):  
Clive Ballard ◽  
Paul Francis ◽  
Anne Corbett
Keyword(s):  
Psychological Symptoms ◽  
Controlled Trial ◽  
Treatment Options ◽  
Significant Risk ◽  
Good Evidence ◽  
Adverse Outcomes ◽  
Pharmacological Intervention ◽  
First Line ◽  
Long Term Treatment ◽  
Behavioral And Psychological Symptoms

Behavioral and psychological symptoms of dementia (BPSD) frequently arise in people with Alzheimer's disease (AD) and other dementias. They cause significant distress and confer risk to the person and others, in addition to presenting a complex clinical challenge for treatment (Ballard et al., 2009b). There is good evidence for the value of first-line management strategies such as psychological interventions and treatment of concurrent medical conditions, particularly pain, which are known to be effective (Ballard et al., 2009b). However, there are limited pharmacological treatment options for severe aggression, which causes significant risk, and for other severe BPSD which do not respond to first-line approaches. The only pharmacological intervention with an adequate evidence base is the prescription of atypical antipsychotics, where 18 placebo-controlled trials have evaluated the effect of treatment over 6–12 weeks. The literature indicates modest but significant benefits in the treatment of aggression and psychosis with risperidone and aripiprazole (Cohen's d standardized effect size of 0.2), uncertain benefits with olanzapine, and no benefits with quetiapine (Ballard and Howard, 2006; Schneider et al., 2006a; Ballard et al., 2009b; Corbett et al., 2012). Unfortunately, the benefits of longer term prescribing are more limited (Schneider et al., 2006b; Ballard et al., 2008) and there have been increasing concerns regarding the potential for serious adverse outcomes, including accelerated cognitive decline, stroke, and death (Schneider et al., 2006b; Ballard et al., 2009a). There is therefore an urgent imperative to identify more effective pharmacological treatments for severe BPSD which have a better safety profile, particularly for long-term treatment and prophylaxis. Despite this urgency, there has been very little effort toward developing or evaluating potential novel therapies for the treatment of key symptoms such as aggression, psychosis, restlessness, and apathy.

Do We Need a Meta-Analysis Update on Antipsychotic Treatment of Behavioral and Psychological Symptoms of Dementia?

2000 ◽  
Vol 12 (S1) ◽  
pp. 305-311 ◽  
Author(s):  
Lon S. Schneider
Keyword(s):  
Clinical Trials ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Antipsychotic Treatment ◽  
Behavioral And Psychological Symptoms

Whether we need another meta-analysis of clinical trials of antipsychotic treatment of patients with behavioral and psychological symptoms of dementia (BPSD) depends on how we define meta analysis and our expectations for the results of such an analysis.

Behavioral and psychological symptoms of dementia: prevalence, symptom groups and their correlates in community-based older adults with dementia in Singapore

2017 ◽  
Vol 29 (8) ◽  
pp. 1363-1376 ◽  
Author(s):  
Janhavi Ajit Vaingankar ◽  
Siow Ann Chong ◽  
Edimansyah Abdin ◽  
Louisa Picco ◽  
Anitha Jeyagurunathan ◽  
...  
Keyword(s):  
Older Adults ◽  
Formal Education ◽  
Psychological Symptoms ◽  
Factor Scores ◽  
Community Based ◽  
Never Married ◽  
Dementia Prevalence ◽  
Physical Conditions ◽  
And Behavior ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground:This study assessed the prevalence and factor structure of behavioral and psychological symptoms of dementia (BPSD) in a community-based sample of older adults with dementia and identified their correlates.Methods:Data collected from 399 Singapore residents with dementia aged 60 years and above, interviewed along with a family/friend during a national survey, were used for this analysis. Neuropsychiatric Inventory Questionnaire assessed older adults’ BPSD. Other data included socio-demographics, dementia severity, cognition, chronic physical conditions, disability, and caregivers’ burden. Exploratory factor analysis assessed BPSD sub-groups, factor scores of which were used to identify socio-demographic, and clinical correlates.Results:Prevalence of BPSD was 67.9% and 30% of the population had experienced three or more BPSD in the past month. Two distinct and moderately correlated symptom groups representing “psychosis and behavior dysregulation” and “mood disturbance and restlessness” were identified. As factor scores for both the groups increased with older age, poor cognition and caregiver burden, the former was also related to being never married and having no formal education.Conclusions:Study provides evidence of two distinct groups of BPSD and their important correlates. Clinicians treating BPSD should consider their age and cognitive impairment and be cognizant of their caregivers’ burden.

scholarly journals Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy (Preprint)

2021 ◽  
Author(s):  
Eunhee Cho ◽  
Sujin Kim ◽  
Sinwoo Hwang ◽  
Eunji Kwon ◽  
Seok-Jae Heo ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Prospective Observational Study ◽  
Psychological Symptoms ◽  
Information Criterion ◽  
Activity Levels ◽  
Contributing Factors ◽  
Factors Associated ◽  
Physical Activity Levels ◽  
Behavioral And Psychological Symptoms

BACKGROUND Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors—circadian rhythm–related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states—on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. OBJECTIVE The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. METHODS A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. RESULTS Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day’s sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; <i>P</i>=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; <i>P</i>=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. CONCLUSIONS BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.

scholarly journals Intramuscular Olanzapine in the Management of Behavioral and Psychological Symptoms in Hospitalized Older Adults: A Retrospective Descriptive Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Silvia Duong ◽  
Kam-Tong Yeung ◽  
Feng Chang
Keyword(s):  
Older Adults ◽  
Adverse Events ◽  
Atypical Antipsychotics ◽  
Psychological Symptoms ◽  
Patient Discharge ◽  
High Risk Population ◽  
Discharge Destination ◽  
Patient Demographics ◽  
Hospitalized Older Adults ◽  
Behavioral And Psychological Symptoms

Background. While behavioral and psychological symptoms are frequent in hospitalized older adults with dementia or delirium, data supporting the off-label use of intramuscular atypical antipsychotics remain scarce. We examined the use of short-acting intramuscular (IM) olanzapine in hospitalized older adults to manage behavioral and psychological symptoms.Methods. A retrospective observational study of inpatients 65 years or older with at least one order for olanzapine IM during admission in urban Ontario Canada was conducted. Patient demographics, prescriptions for olanzapine IM, reason for administration, perceived effectiveness, adverse events, concurrently prescribed psychotropics, comorbidities, and patient discharge destination were recorded.Results. Among 82 patients aged 65–96 years (mean ± SD 79.3 ± 7.7) 85 cases were identified. Cognitive impairment or dementia affected 63.5% and 50.6% had comorbidities. Olanzapine IM was ordered 102 times and 34 patients (41%) received at least one dose. The intended efficacy was achieved in 79.4% of 78 cases of 124 doses given (62.9%). Fourteen (41%) patients who received doses experienced adverse events, with sedation and hypotension being the most common.Conclusions. Olanzapine IM appears effective in hospitalized older adults but is associated with potential adverse events. Structured monitoring and documentation are needed to ensure safe use in this high-risk population.

scholarly journals FACTORS AFFECTING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS IN OLDER ADULTS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S901-S902
Author(s):  
Hwang Sinwoo ◽  
Eunhee Cho
Keyword(s):  
Older Adults ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Psychological Symptoms ◽  
Severe Depression ◽  
Melatonin Level ◽  
Aggressive Behaviors ◽  
Salivary Melatonin ◽  
Waking Up ◽  
Behavioral And Psychological Symptoms

Abstract The purpose of this study was to identify factors predicting behavioral and psychological symptoms of dementia(BPSD) in older adults with Dementia. This is a cross-sectional study, recruiting 157 participants from neurology general hospital as study subjects. Data collection was performed from June 2018 to May 2019. BPSD were classified using a modified version of the Cohen-Mansfield agitation inventory(CMAI), which are physically non-aggressive behaviors(PNAB), physically aggressive behaviors(PGAB), verbally non-aggressive behaviors(VNAB), verbally aggressive behaviors(VAGB). The Cornell scale for depression in dementia(CSDD), korea activity of daily living scale(K-ADL), korean mini-mental state examination(K-MMSE), activity and sleep time through using actigraphy for 2weeks, salivary melatonin and cortisol level at 4 times a day done after waking up, after breakfast, before and after dinner, and medication were measured as influencing factors. The generalized linear mixed model analyses indicated that VNAB and VAGB were associated with severe depression(p&lt;0.01, respectively), low melatonin level at the after waking up (p&lt;0.05, respectively), and high melatonin level before dinner(p&lt;0.05, respectively). On the PNAB and PGAB, severe depression(p&lt;0.05, respectively) and high activity(p&lt;0.05, respectively) showed great influences. These findings suggest that developing of intervention of BPSD must be started with detecting depression, ADL. Considering the factors of each type of symptom, tailoring an individual approach is recommended. In addition, this study identified that the activity through actigraphy and salivary melatonin measurement are useful tools to examine BPSD. It can be helpful in the objective evaluation of BPSD.

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