use of antipsychotic drugs in dementia l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Use of Antipsychotic Drugs in Dementia PowerPoint Presentation
Download Presentation
Use of Antipsychotic Drugs in Dementia

Loading in 2 Seconds...

play fullscreen
1 / 24

Use of Antipsychotic Drugs in Dementia - PowerPoint PPT Presentation


  • 120 Views
  • Uploaded on

Use of Antipsychotic Drugs in Dementia. Josepha A. Cheong, MD University of Florida Departments of Psychiatry and Neurology Chief, Division of Geriatric Psychiatry . What are common behavioral disturbances?. Agitation Physical Verbal Resistiveness Mood Depression Anxiety.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Use of Antipsychotic Drugs in Dementia' - bary


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
use of antipsychotic drugs in dementia

Use of Antipsychotic Drugs in Dementia

Josepha A. Cheong, MD

University of Florida Departments of Psychiatry and Neurology

Chief, Division of Geriatric Psychiatry

what are common behavioral disturbances
What are common behavioral disturbances?
  • Agitation
    • Physical
    • Verbal
    • Resistiveness
  • Mood
    • Depression
    • Anxiety
what are common behavioral disturbances3
What are common behavioral disturbances?
  • Psychosis
    • Disruption in the ability to differentiate real from unreal
    • Hallucinations
    • Illusions
  • “Sundowning”
assessment
Assessment
  • Rule out any environmental disturbance
    • change in home setting
    • change in the staff/family members
    • death of a pet
assessment5
Assessment
  • R/o any possible medical illness
    • urinary tract infection
    • dehydration
assessment6
Assessment
  • R/o drug-drug interactions or drug intolerance
assessment7
Assessment
  • When does the behavior occur
    • constant regardless of stimuli
    • specific time of day
    • with caregiving activity
assessment8
Assessment
  • Endocrine
  • Iatrogenic - consider non-prescription medications
  • Injury
  • Intoxication
treatment
Treatment
  • Behavioral Intervention
  • Antidepressant medications
  • Antipsychotic medications
what is psychosis
What is Psychosis?
  • The state in which a person is unable to differentiate “real” from “unreal”
  • Misperception of stimulus
  • Hallucinations
  • Illusions
  • Delusions
  • Agitation
antipsychotic medications doses adjusted for the geriatric age group
Antipsychotic Medications(doses adjusted for the geriatric age group)
  • haloperidol (Haldol) .5 - 2.0mg
  • risperidone (Risperdal) .5 - 6.0mg
  • olanzapine (Zyprexa) 2.5 - 10.0mg
  • ziprasidone (Geodon) 20-40mg
  • quetiapine (Seroquel) 25mg - 300mg***
general guidelines
General Guidelines
  • Monitor very carefully for side effects
  • Monitor for benefit
  • Consider decreasing the dose if symptoms improve
  • Monitor for increased sedation and adjust the time of dosing
deaths with antipsychotics in elderly patients with behavioral disturbances
Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances
  • 15 out of 17 placebo-controlled trials showed numerical increases in mortality in the drug-treated group compared to the placebo-treated patients
    • N = 5106 involving Risperidone (7 trials), Olanzapine (5 trials), Aripiprazole (3 trials) and Quetiapine (2 trials)
    • ~1.6-1.7 fold increase in mortality in active treatment over placebo
  • Specific causes of these deaths:
    • Heart related events (e.g., heart failure, sudden death) or infections (mostly pneumonia)

FDA Public Health Advisory (4/05)

adverse effects with atypical antipsychotics
Adverse Effects with Atypical Antipsychotics
  • Dyslipidemia
  • Glucose metabolism change
  • Possibility of sudden death secondary to heart failure, cardiac event or infection
adverse effects with atypical antipsychotics16
Adverse Effects with Atypical Antipsychotics

Clinical Considerations:

  • What are the risk factors of this particular patient? (history of cardiac problems, diabetes, and or hypertension?)
  • What alternative treatments have been tried – what was the response?
adverse effects with atypical antipsychotics17
Adverse Effects with Atypical Antipsychotics

Clinical Considerations:

  • What benefits does the patient receive from the particular antipsychotic vs. how is the patient’s behavior without or prior to the initiation of the medication?
  • Have other intervention methods or medications been tried already?
adverse effects with atypical antipsychotics18
Adverse Effects with Atypical Antipsychotics

Recommendations for management:

  • Document need
  • Discussion of alternate treatments
  • Patient/Family consent
  • Use lowest possible doses – monitor for side effects
rules of thumb
Rules of Thumb
  • Not everything needs to be treated with a medication
rules of thumb20
Rules of Thumb
  • Not everything needs to be treated with a medication
  • Start at a low dose and titrate slowly
rules of thumb21
Rules of Thumb
  • Not everything needs to be treated with a medication
  • Start at a low dose and titrate slowly
  • Not everything needs to be treated with a medication
baker act 52 32
Baker Act - 52/32
  • 52 - involuntary evaluation
  • 32 - involuntary committment
referral
Referral

Shands at UF

Inpatient Geriatric Psychiatry Unit

Intake Coordinator 352-265-5411