Freitag, 17. April 2015

Antipsychotic Drugs Hasten Death In Dementia Patients

CJ Arlotta 3/19/2015  7:45AM

Even though practitioners can prescribe several other medications for dementia patients, many physicians still resort to antipsychotics — despite the known increase of potentially damaging side effects. In fact, antipsychotics may actually speed up the dying process in dementia patients more than previously realized, a new study shows.
With the hopes of learning more about the harms associated with using antipsychotics in dementia patients, researchers from the University of Michigan Medical School and VA Center for Clinical Management Research pulled data from the VA national electronic health record system to analyze nearly 91,000 veterans over the age of 65 with dementia. They published their findings in the latest issue of the Journal of the American Medical Association (JAMA).
Dr. Donovan Maust, lead author of the study and assistant professor of Psychiatry at the University of Michigan, told Forbes that many people don’t realize the behavioral and psychological symptoms of dementia. These common symptoms include delusions, hallucinations, agitation and aggression. “These symptoms are very distressing to caregivers and are responsible for a significant amount of the cost associated with caring for patients with dementia,” Maust said. “These behaviors may be dangerous and place the patient at risk for harming themselves, their family and other caregivers.”
“The fact that antipsychotic use persists in spite of the evidence of harm speaks to both how problematic these behaviors are and that there are few other interventions available,” he added.
Alternatives to using antipsychotics for dementia patients include valproic acid, cholinesterase inhibitors and antidepressants. “Non-drug behavioral interventions are important alternatives, but they are generally time-intensive with limited mechanisms for reimbursement, so are not widely available,” Maust said.
The study found that patients taking antipsychotics may face a higher risk of mortality. Risk climbed along with dose in patients using newer, more commonly used antipsychotics. The reasoning for this, according to Maust, is unknown.
“One possibility is that a higher dose means patients are more sedated, which might lead to more falls or more aspiration,” he said. “In frail older patients, such events could ultimately hasten death.”
Patients in the study taking haloperidol had an increased mortality risk of 3.8% compared to matched nonusers. Those participants receiving quetiapine had an increased risk of death of 2.0%. Other tested antipsychotic drugs had fallen somewhere in between.


Weiter auf:
http://www.forbes.com/sites/cjarlotta/2015/03/19/antipsychotic-drugs-hasten-death-in-dementia-patients/