Clinical Queries: Atypical Antipsychotics in the Elderly

Participants received information on the provincial trends for prescribing atypical antipsychotics in seniors and also a snapshot of the prescribing patterns in their own elderly patients.

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Choosing Wisely | Family Medicine, Geriatric Medicine, Psychiatry

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Project Lead

Dr. Lara Cooke, Associate Dean, Continuing Education and Professional Development, University of Calgary
Dr. Chris Symonds, Medical Director, Physician Learning Program, University of Calgary

Data Lead

Alberta Health

Intended Outcomes

this project provides physicians with provincial prescribing trends of atypical antipsychotics in seniors and a snapshot of how many of their senior patients are receiving atypical antipsychotics. Clinical Pearls and links to evidence-informed prescribing support may help physicians reflect on their own practice data to optimize patient outcomes.

An article from our lead physician, Tamara Pringsheim, on the Atypical Antipsychotics project.

http://www.cmajopen.ca/content/2/4/E225.full.pdf+html

Schneider, L. S., Tariot, P. N., Dagerman, K. S., Davis, S. M., Hsiao, J. K., Ismail, M. S., … Lieberman, J. A. (2006). Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer’s Disease. New England Journal of Medicine, 355(15), 1525–1538.

Full-text: http://www.nejm.org/doi/full/10.1056/NEJMoa061240#t=article

Ballard, C., & Waite, J. (2006). The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. The Cochrane Database of Systematic Reviews, (1), CD003476.

http://www.ncbi.nlm.nih.gov/pubmed/16437455

Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J.-H., Ewing, B., … Shekelle, P. G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA: The Journal of the American Medical Association, 306(12), 1359–1369.

Full-text: http://jama.jamanetwork.com/article.aspx?articleid=1104423

Flaherty, J. H., Gonzales, J. P., & Dong, B. (2011). Antipsychotics in the treatment of delirium in older hospitalized adults: a systematic review. Journal of the American Geriatrics Society, 59 Suppl 2, S269–276.

http://www.ncbi.nlm.nih.gov/pubmed/22091572

Sink, K. M., Holden, K. F., & Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA: The Journal of the American Medical Association, 293(5), 596–608.

Full-text: http://jama.jamanetwork.com/article.aspx?articleid=200265

Gill, S. S., Bronskill, S. E., Normand, S.-L. T., Anderson, G. M., Sykora, K., Lam, K., … Rochon, P. A. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146(11), 775–786.

http://www.ncbi.nlm.nih.gov/pubmed/17548409

Rochon, P. A., Normand, S.-L., Gomes, T., Gill, S. S., Anderson, G. M., Melo, M., … Gurwitz, J. H. (2008). Antipsychotic therapy and short-term serious events in older adults with dementia. Archives of Internal Medicine, 168(10), 1090–1096.

Full-text: http://archinte.jamanetwork.com/article.aspx?articleid=414239

U.S. Food and Drug Administration, U.S. Department of Health and Human Services. (2005). FDA public health advisory: deaths with antipsychotics in elderly Patients with behavioral disturbances Full-text: http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/drugsafetyinformationforheathcareprofessionals/publichealthadvisories/ucm053171.htm

Contact Info

Please email plp@ucalgary.ca for more information and to participate.