Antipsychotics

Question 1

What is the RR of mortality for all antipsychotics and each individual?

Answer 1

1.54
Risperidone = 1.3
Quetiapine = 1.67
Olanzapine = 1.91

Question 2

What is the overall absolute risk increase of mortality with antipsychotic use?

Answer 2

1-2%

Question 3

What are adverse side effects for atypical antipsychotics for BPSD?

Answer 3

Mortality
Stroke
Extrapyramidal symptoms
Somnolence
Abnormal gait
Falls
Fracture
Edema
UTI
OH
Lower seizure threshold
Weight gain

Question 4

What are 4 concerns from the Cochrane review on antipsychotics for delirium in hospitalized patients?

Answer 4

1. Did not reduce delirium severity, resolve symptoms or alter mortality
2. No different between typical and atypical for severity, symptom resolution, mortality and AEs
3. EPS not more frequent with antipsychotics
4. No reported data on duration, LOS, disposition or HRQOL

• Antipsychotics vs. non antipsychotics
  o Did not reduce delirium severity
  o No evidence for resolution of delirium
  o No change in mortality
  o No difference in EPS
• Atypicals vs. typicals
  o No difference in delirium severity
  o No difference for resolution of delirium
  o No change in mortality
  o No difference in EPS
• No reports on:
  o Duration of delirium
  o Hospital LOS
  o Discharge disposition
  o HRQOL

Question 5

What symptoms of BPSD are likely to respond to antipsychotic therapy?

Answer 5

Delusions
Hallucinations
Suspiciousness
Defensive
Physical
Restless/anxious

Question 6

What are the recommendations regarding duration of antipsychotic use for BPSD?

Answer 6

Most BPSD don’t persist for longer than 3 months
Cochrane review shows that discontinuing at this time had little or no effect on symptoms
Taper dose 25-50% q1-2 weeks
Monitor for recurrence - initiate non med, restart antipsychotics with goal to stop again in 3 months, make at least 2 attempts

Question 7

List THREE factors that are considered when determining severity of agitation/psychosis when determining need for pharmacologic therapy

Answer 7

THREE factors that are considered when determining severity
* Physical danger (self and others)
* Emotional suffering
* Degree of disability