Nowadays, with our increasingly aged population, it is probable that the main cause of psychotic symptoms in the West is dementia. But what is less obvious is that most of the symptoms of demented patients may actually be due to delirium (that is, to acute confusional states). Full Article →
British researchers find that a 10% increase in pain medication resulted in a dramatic reduction in the use of antipsychotic and other medications. “When people with dementia are showing distress reactions this may be due to them experiencing pain or discomfort, yet too often rather than trying to identify and relieve this symptom they are needlessly given anti-psychotic drugs to calm them and keep them quiet,” said the head of quality and dementia care for Four Seasons Health Care, which conducted the (non-peer reviewed) study.
The Cochrane Library reports that “many older people with Alzheimer’s dementia and NPS (neuropsychiatric symptoms) can be withdrawn from chronic antipsychotic medication without detrimental effects on their behavior… the results of this review suggest that discontinuation programmes could be incorporated into routine practice. However, two studies of people whose agitation or psychosis had previously responded well to antipsychotic treatment found an increased risk of relapse or shorter time to relapse after discontinuation.”
A 15-year prospective study, in the British Medical Journal this week, of 1063 subjects by researchers from the University of Bordeaux and Harvard University found that use of benzodiazepines raises the risk of dementia by approximately 50%. The researchers recommend that “physicians should carefully assess the expected benefits of the use of benzodiazepines in the light of these adverse effects and, whenever possible, limit prescription to a few weeks.”
The Office of the Inspector General finds that 99.5% of nursing facilities in the United States are non-compliant regarding federal regulations concerning antipsychotic use. This report is a review of an earlier study by the Health and Human Services Office of the Inspector General; since the previous study the Centers for Medicare & Medicaid Services has implemented an initiative amid at reducing antipsychotic use in nursing homes by 15% by the end of 2012.
An amendment to an FDA bill, proposed by Senators Herb Kohl, Charles Grassley, and Richard Blumenthal to “ensure that these drugs are being appropriately used to treat people with mental illnesses, not used to curb behavioral symptoms of Alzheimer’s or other dementias,” failed to pass in the Senate despite passage of the bill to which it was attached.
Senators Chuck Grassley of Iowa, Herb Kohl of Wisconsin and Richard Blumenthal of Connecticut filed an amendment to the Food and Drug Administration Safety and Innovation Act yesterday in the United States Senate, “intended to empower (nursing home) residents and their loved ones in the decisions about the drugs prescribed for them.” The amendment calls for education regarding non-pharmacological interventions along with possible risks and side effects of medication.
A retrospective study of 13,535 long-term Kaiser Permanente members found that depressive symptoms in mid-life (1964-1973 for this cohort) were associated with a 20% greater risk of developing dementia. Depression in later life (1994-2000) was associated with a 70% increased risk. Depression in both mid- and late-life posed an 80% increased risk. The study appears in the May issue of Archives of General Psychiatry.
The AARP has joined an “unprecedented class-action lawsuit” against a California nursing home accused of using antipsychotics without informed consent from residents or family members. “It’s critical that individual people who are harmed by these bad practices are able to seek to enforce their own rights,” said the senior counsel for AARP Foundation Litigation, “There’s a sense that because a person is in a nursing home, they automatically consent to have these drugs administered to them. That’s patently ridiculous.”
The Center for Medicare Advocacy advised yesterday that nursing facilities could realize huge savings by eliminating “inappropriate and life-threatening” antipsychotic drugs. The statement added to testimony at a Senate Special Committee on Aging hearing held last week. The statement also advised that more than 90% of nursing facilities were inadequately staffed, resulting in unnecessary trips to the emergency room.
Researchers at the University of Milan and King’s College, London thoroughly reviewed the literature available on Medline and Cochrane regarding the use of benzodiazepines in anxiety, affective and psychotic disorders, as well as the available literature on benzos’ adverse effects. They conclude that the wide use that benzos have achieved in psychiatric and non-psychiatric disorders is not supported by the scientific evidence. There is “robust” evidence for short-term use in panic disorder and generalized anxiety disorder, “intermediate” evidence for social anxiety disorder and “poor” evidence for PTSD and OCD. However, the side-effects found in long-term use, and the risks of abuse and withdrawal effects “recommend a more cautious use of BZDs (short-term) than previously achieved.” Results will appear in European Psychiatry.
An Office of the Inspector General report says that nearly nine out of 10 prescriptions for antipsychotics given to Medicare beneficiaries are for unapproved uses. The dangers include an increased risk of death, life-threatening nervous system problems, movement disorders, high blood sugar, diabetes, pneumonia, ulcers, and low blood pressure. Medicare is calling for a 15% reduction in antipsychotic use in nursing homes, though the use of antipsychotics often begins, is maintained, or is increased in hospitals.
Researchers in the Netherlands followed 248 nursing home residents with dementia for two years, finding that even 25% of the defined daily dose of SSRIs increase the risk of injurious falls by 31%. At the full defined daily dose, the risk rose by 298%. The addition of hypnotics or sedatives increased the risk even more. Results appear in the May issue of British Journal of Clinical Pharmacology.
Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic “sick role” concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.
27 (24%) of 112 geriatric patients admitted consecutively to an inpatient psychiatric unit had delirium from underlying medical conditions that was misdiagnosed as a psychiatric disorder, according to research presented at the annual meeting of the American Association for Geriatric Psychiatry. “If a patient has a previous psychiatric history, physicians are not as scrupulous or as careful to screen them for underlying medical issues,” said Dr. Meera Balasubramaniam; ”they are more likely to send them to a psych unit, thinking all of their behavioral manifestations are actually psychiatric.”
In a study of 10,969 older patients treated with antipsychotics in Quebec, Canada, researchers found a 2.19 times greater risk of heart attack in the first 30 days than in a matched set of non-antipsychotic users. “… physicians should limit prescribing of antipsychotic drugs to patients with dementia and instead use other techniques when available, such as environmental and behavioral strategies, to keep these patients safe and engaged,” the authors said. Results will appear in the Archives of Internal Medicine.
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Arkansas’ lawsuit against Johnson & Johnson for false and misleading claims regarding Risperdal is set to begin today, the fourth time J&J has a faced a state’s complaints about the drug. Arkansas is accusing J&J of hiding the serious health risks of Risperdal, and of promoting it for unapproved uses such as the treatment of dementia and Alzheimer’s disease, despite evidence that the drug increased the risk of death in elderly patients. The minimum penalty of $5,000 per prescription would total an award of $1.25 billion.
Recent investigations by the California Department of Public Health found that in 18 of 31 nursing homes in San Francisco (plus one outside of the Bay area) pharmacists responsible for reviewing medication of residents regularly allowed medically inappropriate and potentially fatal antipsychotics. Seroqual was routinely prescribed off-label, for instance, at unsafe levels and in unsafe combinations with other drugs.
The Centers for Medicare and Medicaid Services is launching an initiative to curb the use of antipsychotic medications for nursing home residents with dementia. The plan will promote awareness of non-drug approaches to treat aggression and agitation and strengthen regulatory oversight.
Federal prosecutors have rejected as insufficient the $1 billion settlement reached two months ago between Johnson & Johnson and prosecutors in Philadelphia to resolve claims related to fraudulent and unapproved marketing of Risperdal for, among other things, children and the elderly.
Researchers from the University of North Carolina found that activity-based therapy and care reduced the use of antipsychotics in a study of 107 people with dementia. They presented their research today at the Alzheimer’s Disease International conference. ”These drugs double the risk of death and treble the risk of stroke yet have little benefit,” said Dr. Anne Corbett of the Alzheimer’s society, “It is essential we bring an end to this chemical cosh now.”
In “the first major study of the impact of humour therapy on mood, agitation, behavioural disturbances and social engagement in dementia,” researchers in Australia found both short and long-term decreases in agitation.
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In a review and meta-analysis of double-blind, placebo-controlled, randomly-assigned trials of antidepressants marketed in the U.S., researchers at the University of California failed to find evidence supporting the use of antidepressants for the treatment of depression in dementia. The results were published in the Journal of the American Geriatric Society.
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