본문 바로가기
KERD
논문KCI 등재

Understanding of Antipsychotics in Elderly Patients with Dementia

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

주제분류신경과학

초록

Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.

Abstract

Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.

참고문헌 (94)

  1. Jeste DV, "ACNP White Paper: update on use of antipsychotic drugs in elderly persons with dementia", Neuropsychopharmacology, 33, pp.957~970 (2008)
  2. Ray WA, "Atypical antipsychotic drugs and the risk of sudden cardiac death", N Engl J Med, 360, pp.225~235 (2009)
  3. Wang PS, "Risk of death in elderly users of conventional vs. atypical antipsychotic medications", N Engl J Med, 353, pp.2335~2341 (2005)
  4. Gareri P, "Conventional and atypical antipsychotics in the elderly: a review", Clin Drug Investig, 23, pp.287~322 (2003)
  5. Gareri P, "Adverse effects of atypical antipsychotics in the elderly:a review", Drugs Aging, 23, pp.937~956 (2006)
  6. Markowitz JS, "Atypical antipsychotics. Part I:Pharmacology, pharmacokinetics, and efficacy", Ann Pharmacother, 33, pp.73~85 (1999)
  7. Seeman P, "Atypical antipsychotics: mechanism of action", Can J Psychiatry, 47, pp.27~38 (2002)
  8. Burris KD, "Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors", J Pharmacol Exp Ther, 302, pp.381~389 (2002)
  9. Shayegan DK, "Atypical antipsychotics: matching receptor profile to individual patient’s clinical profile", CNS Spectr, 9(10Suppl 11), pp.6~14 (2004)
  10. Leucht S, "How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials", Mol Psychiatry, 14, pp.429~447 (2009)
  11. Khan AY, "Examining concentration-dependent toxicity of clozapine: role of therapeutic drug monitoring", J Psychiatr Pract, 11, pp.289~301 (2005)
  12. Pollock BG, "Psychotropic drugs and the aging patient", Geriatrics, 53(Suppl 1), pp.S20~S24 (1998)
  13. Schoemaker H, "Neurochemical characteristics of amisulpride, an atypical dopamine D2", D3 receptor antagonist with both presynaptic and limbic selectivity, 1997, pp.280, 83~97
  14. Shahid M, "Asenapine: a novel psychopharmacologic agent with a unique human receptor signature", J Psychopharmacol, 23, pp.65~73 (2009)
  15. Maher AR, "Summary of the comparative effectiveness review on off-label use of atypical antipsychotics", J Manag Care Pharm, 18(5 Suppl B), pp.S1~S20 (2012)
  16. Salzman C, "Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy", J Clin Psychiatry, 69, pp.889~898 (2008)
  17. Herrmann N, "Pharmacologic management of neuropsychiatric symptoms of Alzheimer disease", Can J Psychiatry, 52, pp.630~646 (2007)
  18. Correll CU, "Real-life dosing with second-generation antipsychotics", J Clin Psychiatry, 66, pp.1610~1611 (2005)
  19. Lacro JP, "Serum haloperidol levels in older psychotic patients", Am J Geriatr Psychiatry, 4, pp.229~236 (1996)
  20. 곽용태, "Late-Onset Psychosis; Is It Real?", Dementia and Neurocognitive Disorders(대한치매학회지), 14(1), pp.1~11 (2015), 대한치매학회[DOI]
  21. 곽용태, "알츠하이머병에서 망상", Dementia and Neurocognitive Disorders(대한치매학회지), 13(3), pp.63~73 (2014), 대한치매학회[DOI]
  22. Ereshefsky L, "Pharmacokinetics and drug interactions: update for new antipsychotics", J Clin Psychiatry, 57(Suppl 11), pp.12~25 (1996)
  23. Correll CU, "Antipsychotic use in children and adolescents: minimizing adverse effects to maximize outcomes", J Am Acad Child Adolesc Psychiatry, 47, pp.9~20 (2008)
  24. Casey DE, "Switching patients to aripiprazole from other antipsychotic agents:a multicenter randomized study", Psychopharmacology (Berl), 166, pp.391~399 (2003)
  25. violent Behaviour in Inpatient Psychiatric Settings and Emergency Departments, "Violence:The Short-term Management of Disturbed", pp.2005, Royal College of Nursing (Great Britain)
  26. Milbrandt EB, "Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients", Crit Care Med, 33, pp.226~229 (2005)
  27. Dorey JM, "Behavioral and psychological symptoms of dementia and bipolar spectrum disorders: review of the evidence of a relationship and treatment implications", CNS Spectr, 13, pp.796~803 (2008)
  28. Ballard CG, "Management of agitation and aggression associated with Alzheimer disease", Nat Rev Neurol, 5, pp.245~255 (2009)
  29. Gareri P, "Risperidone in the treatment of behavioral disorders in elderly patients with dementia", Arch Gerontol Geriatr Suppl, 7, pp.173~182 (2001)
  30. Gareri P, "Comparison of the efficacy of new and conventional antipsychotic drugs in the treatment of behavioral and psychological symptoms of dementia (BPSD)", Arch Gerontol Geriatr Suppl, (9), pp.207~215 (2004)
  31. De Deyn PP, "A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia", Neurology, 53, pp.946~955 (1999)
  32. Teri L, "Treatment of agitation in AD: a randomized, placebo-controlled clinical trial", Neurology, 55, pp.1271~1278 (2000)
  33. Lonergan E, "Haloperidol for agitation in dementia", Cochrane Database Syst Rev, (2), pp.CD002852~ (2002)
  34. Ballard C, "Neuroleptic drugs in dementia: benefits and harm", Nat Rev Neurosci, 7, pp.492~500 (2006)
  35. Schneider LS, "Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials", Am J Geriatr Psychiatry, 14, pp.191~210 (2006)
  36. Schneider LS, "Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials", JAMA, 294, pp.1934~1943 (2005)
  37. Ballard C, "A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial)", PLoS Med, 5, pp.e76~ (2008)
  38. Schneider LS, "Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease", N Engl J Med, 355, pp.1525~1538 (2006)
  39. Sultzer DL, "Clinical symptom responses to atypical antipsychotic medications in Alzheimer’s disease: phase 1 outcomes from the CATIE-AD effectiveness trial", Am J Psychiatry, 165, pp.844~854 (2008)
  40. Vigen CL, "Cognitive effects of atypical antipsychotic medications in patients with Alzheimer’s disease: outcomes from CATIE-AD", Am J Psychiatry, 168, pp.831~839 (2011)
  41. Ballard C, "The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease", Cochrane Database Syst Rev, (1), pp.CD003476~ (2006)
  42. Mowat D, "CSM warning on atypical psychotics and stroke may be detrimental for dementia", BMJ, 328, pp.1262~ (2004)
  43. Lee PE, "Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review", BMJ, 329, pp.75~ (2004)
  44. Liperoti R, "All-cause mortality associated with atypical and conventional antipsychotics among nursing home residents with dementia: a retrospective cohort study", J Clin Psychiatry, 70, pp.1340~1347 (2009)
  45. Huybrechts KF, "Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study", BMJ, 344, pp.e977~ (2012)
  46. Sacchetti E, "Risk of stroke with typical and atypical anti-psychotics: a retrospective cohort study including unexposed subjects", J Psychopharmacol, 22, pp.39~46 (2008)
  47. Trifirò G, "All-cause mortality associated with atypical and typical antipsychotics in demented outpatients", Pharmacoepidemiol Drug Saf, 16, pp.538~544 (2007)
  48. Trifirò G, "Use of antipsychotics in elderly patients with dementia: do atypical and conventional agents have a similar safety profile?", Pharmacol Res, 59, pp.1~12 (2009)
  49. Haddad PM, "Antipsychotic-related QTc prolongation, torsade de pointes and sudden death", Drugs, 62, pp.1649~1671 (2002)
  50. Titier K, "Atypical antipsychotics: from potassium channels to torsade de pointes and sudden death", Drug Saf, 28, pp.35~51 (2005)
  51. Taylor DM, "Antipsychotics and QT prolongation", Acta Psychiatr Scand, 107, pp.85~95 (2003)
  52. Reilly JG, "QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients", Lancet, 355, pp.1048~1052 (2000)
  53. Thomas SH, "Drugs, QT interval abnormalities and ventricular arrhythmias", Adverse Drug React Toxicol Rev, 13, pp.77~102 (1994)
  54. De Ponti F, "QT-interval prolongation by non-cardiac drugs: lessons to be learned from recent experience", Eur J Clin Pharmacol, 56, pp.1~18 (2000)
  55. Ray WA, "Antipsychotics and the risk of sudden cardiac death", Arch Gen Psychiatry, 58, pp.1161~1167 (2001)
  56. Alvarez PA, "QT alterations in psychopharmacology: proven candidates and suspects", Curr Drug Saf, 5, pp.97~104 (2010)
  57. Glassman AH, "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death", Am J Psychiatry, 158, pp.1774~1782 (2001)
  58. Chung AK, "Effects on prolongation of Bazett’s corrected QT interval of seven second-generation antipsychotics in the treatment of schizophrenia: a meta-analysis", J Psychopharmacol, 25, pp.646~666 (2011)
  59. Zareba W, "Antipsychotic drugs and QT interval prolongation", Psychiatr Q, 74, pp.291~306 (2003)
  60. Liperoti R, "Conventional and atypical antipsychotics and the risk of hospitalization for ventricular arrhythmias or cardiac arrest", Arch Intern Med, 165, pp.696~701 (2005)
  61. Pariente A, "Antipsychotic use and myocardial infarction in older patients with treated dementia", Arch Intern Med, 172, pp.648~653 (2012)
  62. Alexopoulos GS, "Using antipsychotic agents in older patients", J Clin Psychiatry, 65(Suppl 2), pp.5~99 (2004)
  63. Gill SS, "Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study", BMJ, 330, pp.445~ (2005)
  64. Liperoti R, "Cerebrovascular events among elderly nursing home patients treated with conventional or atypical antipsychotics", J Clin Psychiatry, 66, pp.1090~1096 (2005)
  65. Douglas IJ, "Exposure to antipsychotics and risk of stroke:self controlled case series study", BMJ, 337, pp.a1227~ (2008)
  66. Herrmann N, "Do atypical antipsychotics cause stroke?", CNS Drugs, 19, pp.91~103 (2005)
  67. Tarsy D, "Effects of newer antipsychotics on extrapyramidal function", CNS Drugs, 16, pp.23~45 (2002)
  68. Weiden PJ, "EPS profiles: the atypical antipsychotics are not all the same", J Psychiatr Pract, 13, pp.13~24 (2007)
  69. Wirshing WC, "Movement disorders associated with neuroleptic treatment", J Clin Psychiatry, 62(Suppl 21), pp.15~18 (2001)
  70. Orr MW, "The effects of neuroleptic drugs on 5-hydroxytryptamine induced platelet aggregation in schizophrenic patients", Br J Clin Pharmacol, 11, pp.255~259 (1981)
  71. Mulsant BH, "Correlates of anticholinergic activity in patients with dementia and psychosis treated with risperidone or olanzapine", J Clin Psychiatry, 65, pp.1708~1714 (2004)
  72. Wetterling T, "Bodyweight gain with atypical antipsychotics. A comparative review", Drug Saf, 24, pp.59~73 (2001)
  73. Allison DB, "Antipsychotic-induced weight gain: a comprehensive research synthesis", Am J Psychiatry, 156, pp.1686~1696 (1999)
  74. Ananth J, "Atypical antipsychotic induced weight gain: pathophysiology and management", Ann Clin Psychiatry, 16, pp.75~85 (2004)
  75. Buse JB, "A retrospective cohort study of diabetes mellitus and antipsychotic treatment in the United States", J Clin Epidemiol, 56, pp.164~170 (2003)
  76. Cohen D, "Atypical antipsychotics and new onset diabetes mellitus. An overview of the literature", Pharmacopsychiatry, 37, pp.1~11 (2004)
  77. Wirshing DA, "Novel antipsychotics and new onset diabetes", Biol Psychiatry, 44, pp.778~783 (1998)
  78. Mukherjee S, "Diabetes mellitus in schizophrenic patients", Compr Psychiatry, 37, pp.68~73 (1996)
  79. Gaulin BD, "Clozapine-associated elevation in serum triglycerides", Am J Psychiatry, 156, pp.1270~1272 (1999)
  80. Wirshing DA, "The effects of novel antipsychotics on glucose and lipid levels", J Clin Psychiatry, 63, pp.856~865 (2002)
  81. Wu RR, "Effects of typical and atypical antipsychotics on glucose-insulin homeostasis and lipid metabolism in first-episode schizophrenia", Psychopharmacology (Berl), 186, pp.572~578 (2006)
  82. Koro CE, "An assessment of the independent effects of olanzapine and risperidone exposure on the risk of hyperlipidemia in schizophrenic patients", Arch Gen Psychiatry, 59, pp.1021~1026 (2002)
  83. Rondanelli M, "No effect of atypical antipsychotic drugs on weight gain and risk of developing type II diabetes or lipid abnormalities among nursing home elderly patients with Alzheimer’s disease", Minerva Med, 97, pp.147~151 (2006)
  84. Sicras-Mainar A, "Metabolic syndrome in outpatients receiving antipsychotic therapy in routine clinical practice: a cross-sectional assessment of a primary health care database", Eur Psychiatry, 23, pp.100~108 (2008)
  85. Rettenbacher MA, "Neutropenia induced by second generation antipsychotics: a prospective investigation", Pharmacopsychiatry, 43, pp.41~44 (2010)
  86. Croarkin P, "Acute neutropenia in a patient treated with quetiapine", Psychosomatics, 42, pp.368~ (2001)
  87. Li X, "Potential role of a quetiapine metabolite in quetiapine-induced neutropenia and agranulocytosis", Chem Res Toxicol, 25, pp.1004~1011 (2012)
  88. Trifirò G, "Association of community-acquired pneumonia with antipsychotic drug use in elderly patients: a nested case-control study", Ann Intern Med, 152, pp.418~425 (2010)
  89. Parker C, "Antipsychotic drugs and risk of venous thromboembolism: nested case-control study", BMJ, 341, pp.c4245~ (2010)
  90. Allenet B, "Antipsychotic drugs and risk of pulmonary embolism", Pharmacoepidemiol Drug Saf, 21, pp.42~48 (2012)
  91. Kleijer BC, "Antipsychotic drug use and the risk of venous thromboembolism in elderly patients", J Clin Psychopharmacol, 30, pp.526~530 (2010)
  92. Axelsson S, "In vitro effects of antipsychotics on human platelet adhesion and aggregation and plasma coagulation", Clin Exp Pharmacol Physiol, 34, pp.775~780 (2007)
  93. Haddad PM, "Antipsychotic-induced hyperprolactinaemia:mechanisms, clinical features and management", Drugs, 64, pp.2291~2314 (2004)
  94. Kinon BJ, "Hyperprolactinemia in response to antipsychotic drugs: characterization across comparative clinical trials", Psychoneuroendocrinology, 28(Suppl 2), pp.69~82 (2003)

관련 논문AI추천

알츠하이머 치매의 행동심리증상에서 비정형 항정신병약물이지은, 한명일, 황태영대한노인정신의학회 · 노인정신의학2015 · 제19권 제2호Ziprasidone for the Treatment of Delirium: Case StudiesSung-Won Jung대한정신약물학회 · Clinical Psychopharmacology and Neuroscience2010 · 제8권 제2호치매에서의 행동 및 심리 증상에 대한 약물치료문은수, 박제민, 이병대, 이영민, 정영인, 정희정대한노인정신의학회 · 노인정신의학2013 · 제17권 제2호항정신병 약물 사용 및 치매의 심리행동 증상과 알츠하이머 환자의 인지능력 저하와의 연관성장준호, 전덕인, 정명훈, 홍나래, 홍현주대한노인정신의학회 · 노인정신의학2021 · 제25권 제2호Clinical Practice Guidelines for Dementia: Recommendations for the Pharmacological Treatment of Behavioral and Psychological SymptomsByeon Gihwan, Chin Juhee, Choi Miyoung, Hong Yun Jeong, Jang Hyemin, Jang Jae-Won, Jung Young Hee, Kang Dong Woo, Kim Geon Ha, Kim Hee-jin, Kim Ko Woon, Kim Yeshin, Lee Juyoun, Lee Sun Min, Lim Jae-Sung, Na Seunghee, Oh Seong-il, Park Kee Hyung, Park Young Ho, Rhee Hak Young, San Lee Jin, Shim YongSoo, Shin Joon Hyun, Suh Jeewon, Um Yoo Hyun, Wang Sheng-Min, Yang YoungSoon, Yoon Bora대한치매학회 · Dementia and Neurocognitive Disorders(대한치매학회지)2025 · 제24권 제1호Delirium Associated with Olanzapine Therapy in an Elderly Male with Bipolar Affective DisorderAshish Aggarwal, Ravi C. Sharma대한신경정신의학회 · PSYCHIATRY INVESTIGATION2010 · 제7권 제2호

이 간행물의 다른 논문 (5건)