Journal Mobile Options
Table of Contents
Vol. 76, No. 4, 2007
Issue release date: June 2007
Psychother Psychosom 2007;76:213–218
(DOI:10.1159/000101499)

Meta-Analysis of the Effectiveness of Atypical Antipsychotics for the Treatment of Behavioural Problems in Persons with Dementia

Yury C.A. · Fisher J.E.
Department of Psychology, University of Nevada, Reno, Nev., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: To review published reports of the usage of atypical antipsychotics for behavioural problems of dementia patients. Methods: The electronic database Medline was searched from 1999 to 2006 with a combination of search terms including ‘behavioural problems’ and ‘atypical antipsychotics’. Results: Thirteen eligible studies were included in the overall analysis. The total number of participants was 1,683, of whom 1,015 received medication and 668 received placebo. Medications studied were risperidone, olanzapine, and quetiapine. Other studies examined other types of medications, such as typical versus atypical antipsychotics, but only data for atypical antipsychotics were included in the meta-analysis. The mean effect size for 7 placebo-controlled studies was 0.45 (95% CI = 0.16–0.74) for atypical antipsychotics, and 0.32 (95% CI = 0.10–0.53) for placebo. The mean effect size of all 13 studies included in the analysis was 0.31 (95% CI = 0.08–0.54). Conclusions: In general, effect sizes of atypical antipsychotics for behavioural problems are medium, and there are no statistically or clinically significant differences between atypical antipsychotics and placebo.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC: Mental and behavioral disturbances in dementia: findings from the Cache County Study on memory in aging. Am J Psychiatry 2000;157:708–714.
  2. Parnetti L, Amici S, Lanari A, Gallai V: Pharmacological treatment of non-cognitive disturbances in dementia disorders. Mech Ageing Dev 2001;122:2063–2069.
  3. Levy ML, Cummings JL, Fairbanks LA, Bravi D, Calvani M, Carta A: Longitudinal assessment of symptoms of depression, agitation, and psychosis in 181 patients with Alzheimer’s disease. Am J Psychiatry 1996;153:1438–1443.
  4. Lyketsos CG, Steele C, Galik E, Rosenblatt A, Steinberg M, Warren A, Sheppard JM: Physical aggression in dementia patients and its relationship to depression. Am J Psychiatry 1999;156:66–71.
  5. Devanand DP, Jacobs DM, Tang MX, Del Castillo-Castaneda C, Sano M, Marder K, Bell K, Bylsma FW, Brandt J, Albert M, Stern Y: The course of psychopathologic features in mild to moderate Alzheimer’s disease. Arch Gen Psychiatry 1997;54:257–263.
  6. Verma SD, Davidoff DA, Kambhampati KK: Management of the agitated elderly patient in the nursing home: the role of the atypical antipsychotics. J Clin Psychiatry 1998;59:50–55.
  7. Sweet RA, Pollock BG: Neuroleptics in the elderly: guidelines for monitoring. Harv Rev Psychiatry 1995;2:327–335.
  8. Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA: Risk of death in elderly users of conventional vs atypical antipsychotic medications. N Engl J Med 2005;353:2335–2341.
  9. Colenda CC, Mickus MA, Marcus SC, Tanielian TL, Pincus HA: Comparison of adult and geriatric psychiatric practice patterns: findings from the American Psychiatric Association’s Practice Research Network. Am J Geriatr Psychiatry 2002;10:609–617.
  10. Giron MS, Forsell Y, Bernsten C, Thorslun M, Winblad B, Fastbom J: Psychotropic drug use in elderly people with and without dementia. Int J Geriatr Psychiatry 2001;16:900–906.
  11. Briesacher BA, Limcangco R, Simoni-Wastila L, et al: The quality of antipsychotic drug prescribing in nursing homes. Arch Intern Med 2005;165:1280–1285.
  12. Hien LT, Cumming RC, Cameron ID, Chen JS, Lord SR, March LM, Schwarz J, Le Couteur DG, Sambrook PN: Atypical antipsychotic medications and risk of falls in residents of aged care facilities. J Am Geriatr Soc 2005;53:1290–1295.
  13. Stoppe G, Staedt J: Psychopharmacology of behavioural disorders in patients with dementia. Gerontol Geriatr 1999;32:153–158.
  14. Sink KM, Holden KF, Yaffe K: Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005;293:596–607.
  15. Leipzig R, Cummings RG, Tinetti ME: Drugs and falls in older people: a systematic review and meta-analysis. 1. Psychotropic drugs. J Am Geriatr Soc 1999;47:30–39.
  16. Maguire GA: Impact of antipsychotics on geriatric patients: efficacy, dosing, and compliance. Prim Care Companion J Clin Psychiatry 2000;2:165–172.

    External Resources

  17. Food and Drug Administration: FDA public health advisory: deaths with antipsychotics in elderly patients with behavioral disturbances. Available at: http://www.fda.gov/cder/drug/InfoSheets/HCP/olanzapineHCP.htm (accessed April 12, 2006).
  18. Thalheimer W, Cook S: How to calculate effect sizes from published research articles: a simplified methodology. Available at: http://work-learning.com/effect_sizes.htm (accessed January 20, 2005).
  19. Ballard C, Margallo-Lana M, Juszczak E, Douglas S, Swann A, Thomas A, O’Brien J, Everratt A, Sadler S, Maddison C, Lee L, Bannister C, Elvish R, Jacoby R: Quetiapine and rivastigmine and cognitive decline in Alzheimer’s disease: randomised double-blind placebo-controlled trial. BMJ 2005;330:874–897.
  20. Brodaty H, Ames D, Snowdon H, Woodward M, Kirwan J, Clarnette R, Lee E, Lyons B, Grossman F: A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry 2003;64:134–143.
  21. Clark WS, Street JS, Feldman PD, Breieret A: The effects of olanzapine in reducing the emergence of psychosis among nursing home patients with Alzheimer’s disease. J Clin Psychiatry 2001;62:34–40.
  22. De Deyn PP, Rabheru K, Rasmussen A, Bocksberger JP, Dautzenberg PL, Eriksson S, Lawloe BA: A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 1999;53:946–955.
  23. De Deyn PP, Carrasco MM, Deberdt W, Jeandel C, Hay DP, Feldman PD, Young CA, Lehman, DL, Breier A: Olanzapine versus placebo in the treatment of psychosis with or without associated behavioral disturbances in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 2004;19:115–126.
  24. Katz IR, Jeste DV, Mintzer JE, Clyde C, Napolitano J, Brecher M: Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. J Clin Psychiatry 1999;60:107–115.
  25. Street JS, Clark S, Gannon KS, Cummings JL, Bymaster FP, Tamura RN, Mitan SJ, Kadam DL, Sanger TM, Fledman PD, Tollefson GD, Breier A: Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry 2000;57:968–976.
  26. Chan W, Lam LC, Choy CN, Leung VP, Li S, Chiu HF: A double-blind randomised comparison of risperidone and haloperidol in the treatment of behavioural and psychological symptoms in Chinese dementia patients. Int J Geriatr Psychiatry 2001;16:1156–1162.
  27. Fontaine CS, Hynan LS, Koch K, Martin-Cook K, Svetlik D, Weiner MF: A double-blind comparison of olanzapine versus risperidone in the acute treatment of dementia-related behavioral disturbances in extended care facilities. J Clin Psychiatry 2003;64:726–730.
  28. Fujikawa T, Takahashi T, Kinoshita A, Kajiyama H, Kurata A, Yamashita H, Yamawaki S: Quetiapine treatment for behavioral and psychological symptoms of patients with senile dementia of Alzheimer type. Neuropsychobiology 2004;49:201–204.
  29. Street JS, Clark WS, Kadam DL, Mitn SJ, Juliar BE, Feldman PD, Breier A: Long-term efficacy of olanzapine in the control of psychotic and behavioral symptoms in nursing home patients with Alzheimer’s dementia. Int J Geriatr Psychiatry 2001;16:S62–S70.

    External Resources

  30. Yoon J, Kim J, Lee H, Shin I, Choi S: Risperidone use in Korean patients with Alzheimer’s disease: optimal dosage and effect on behavioural and psychological symptoms, cognitive function and activities of daily living. Hum Psychopharmacol 2003;18:627–633.
  31. Lavertsky H, Sultzer D: A structured trial of risperidone for the treatment of agitation in dementia. Am J Geriatr Psychiatry 1998;6:127–135.

    External Resources

  32. Rains JC, Penzien DB: Behavioral research and the double-blind placebo-controlled methodology: challenges in applying the biomedical standard to behavioral headache research. Headache 2005;45:479–486.
  33. Cohen J: Statistical Power Analysis for the Behavioural Sciences, ed 2. Hillsdale, Erlbaum, 1988.
  34. Jacobson NS, Traux P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clinical Psychol 2001;59:12–19.
  35. Fava GA: The intellectual crisis of psychiatric research. Psychother Psychosom 2006;75:202–208.
  36. Rosenthal R: The file drawer problem and tolerance for null results. Psychol Bull 1979;86:638–641.

    External Resources

  37. Sensky T: The effectiveness of cognitive therapy for schizophrenia: what can we learn from the meta-analyses? Psychother Psychosom 2005;75:131–135.

    External Resources



Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50