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The effects of abrupt antipsychotic discontinuation in cognitively impaired hospitalised older persons : a pilot study

(2013) AGING & MENTAL HEALTH. 17(1). p.125-132
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Abstract
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 6795) 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.
Keywords
withdrawal, antipsychotics, geriatric, dementia, NURSING-HOME PATIENTS, NEUROLEPTIC DISCONTINUATION, DOUBLE-BLIND, DEMENTIA, WITHDRAWAL, SYMPTOMS, RISK

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Chicago
Azermai, Majda, Mirko Petrovic, Sebastiaan Engelborghs, Monique Elseviers, Stephan Van der Mussele , Hans Debruyne, Lucas Van Bortel, and Robert Vander Stichele. 2013. “The Effects of Abrupt Antipsychotic Discontinuation in Cognitively Impaired Hospitalised Older Persons : a Pilot Study.” Aging & Mental Health 17 (1): 125–132.
APA
Azermai, M., Petrovic, M., Engelborghs, S., Elseviers, M., Van der Mussele , S., Debruyne, H., Van Bortel, L., et al. (2013). The effects of abrupt antipsychotic discontinuation in cognitively impaired hospitalised older persons : a pilot study. AGING & MENTAL HEALTH, 17(1), 125–132.
Vancouver
1.
Azermai M, Petrovic M, Engelborghs S, Elseviers M, Van der Mussele S, Debruyne H, et al. The effects of abrupt antipsychotic discontinuation in cognitively impaired hospitalised older persons : a pilot study. AGING & MENTAL HEALTH. 2013;17(1):125–32.
MLA
Azermai, Majda, Mirko Petrovic, Sebastiaan Engelborghs, et al. “The Effects of Abrupt Antipsychotic Discontinuation in Cognitively Impaired Hospitalised Older Persons : a Pilot Study.” AGING & MENTAL HEALTH 17.1 (2013): 125–132. Print.
@article{2962474,
  abstract     = {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 6795) 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.},
  author       = {Azermai, Majda and Petrovic, Mirko and Engelborghs, Sebastiaan and Elseviers, Monique and Van der Mussele , Stephan and Debruyne, Hans and Van Bortel, Lucas and Vander Stichele, Robert},
  issn         = {1360-7863},
  journal      = {AGING \& MENTAL HEALTH},
  keyword      = {withdrawal,antipsychotics,geriatric,dementia,NURSING-HOME PATIENTS,NEUROLEPTIC DISCONTINUATION,DOUBLE-BLIND,DEMENTIA,WITHDRAWAL,SYMPTOMS,RISK},
  language     = {eng},
  number       = {1},
  pages        = {125--132},
  title        = {The effects of abrupt antipsychotic discontinuation in cognitively impaired hospitalised older persons : a pilot study},
  url          = {http://dx.doi.org/10.1080/13607863.2012.717255},
  volume       = {17},
  year         = {2013},
}

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