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Concerns about the efficacy and safety
of atypical antipsychotics for BPSD persist. In a double-blind,
randomized, placebo-controlled trial, Deberdt et al compared
treatment with risperidone or olanzapine in an outpatient sample
of dementia patients. Neither active medication was better than
placebo, likely secondary to the marked improvement noted in
the placebo group. These authors suggested that the placebo
response may have been related to the nature of the outpatient
population and use of family caregivers as informants, who were
likely sensitive to the extra attention and support provided
by the study. In a retrospective cohort study, Rochon et
al compared dementia patients treated with typical antipsychotics
or atypical antipsychotics to untreated patients. The development
of parkinsonism was 30% more likely with typical antipsychotics
compared with atypical antipsychotics, though untreated patients
were 60% less likely to develop parkinsonism compared with atypical
antipsychotic treatment. Furthermore, users of high doses of
atypical antipsychotics were twice as likely to develop parkinsonism
compared with low or medium doses. While the authors caution
clinicians about use of high doses, the results seem to confirm
that when atypicals are used at appropriate dosages for BPSD,
they are indeed less likely to cause parkinsonism than typical
antipsychotics, and overall, the event rate is remarkably low
given the nature of this frail, elderly population.
Comparison of olanzapine and risperidone
in the treatment of psychosis and associated behavioral disturbances
in patients with dementia
(AM J GERIATR PSYCHIATRY 2005;13:722-730)
WALTER G. DEBERDT, MD,
MAURICE W. DYSKEN, MD,
STEPHEN A. RAPPAPORT, MD,
PETER D. FELDMAN, PHD,
ET AL,
INDIANAPOLIS, IN,
MINNEAPOLIS, MN
VIENNA, AUSTRIA
Atypical antipsychotics and parkinsonism
(ARCH INTERN MED 2005;165:1882-1888)
PAULA A. ROCHON, MD, MPH,
FRCPC,
THERESE A. STUKEL, PHD,
KATHY SYKORA, MSC,
SUDEEP GILL, MD,
ET AL,
TORONTO, ON
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