18 Mar Antipsychotic Medications Linked To Higher Mortality In Dementia Patients

Posted at 20:23h in Author Interviews, Cognitive Issues, JAMA, University of Michigan by

Donovan Maust, MD, MS Assistant Professor of Psychiatry University of Michigan Research Scientist, Center for Clinical Management Research VA Ann Arbor Healthcare SystemMedicalResearch.com Interview with:
Donovan Maust, MD, MS
Assistant Professor of Psychiatry
University of Michigan
Research Scientist, Center for Clinical Management Research
VA Ann Arbor Healthcare System

Medical Research: What is the background for this study? What are the main findings?

Dr. Maust: From a recent government report, we known that about 1/3 of older adults with dementia in nursing homes and about 14% of those in the community have been prescribed an antipsychotic. While providers focus on what benefit the treatment they offer, it is important to also be aware of the potential harms, particularly when it is death. Prior estimates came from relatively short studies and showed a 1% increase. This paper finds that, over 180 days, the increased mortality comparing antipsychotic users to matched non-users is about 2 to 5 times higher.

Medical Research: What should clinicians and patients take away from your report?

Dr. Maust:

1. The decision to prescribe an antipsychotic is associated with higher risk of mortality for patients with dementia than previously described.

  1. Among antipsychotics, the risk of use compared to non-use is lowest for quetiapine and highest for haloperidol.
  2. Among the atypical antipsychotics, high-dose use (e.g., risperidone >2.5mg/day) is associated with 3.5% higher mortality than low-dose use (0.13-1.00mg/day). [Please note: this may also be true for haloperidol, but the dose analysis was limited to the atypical antipsychotics.]

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Maust:  We would like to learn more about how antipsychotic prescribing practice has changed over the past decade. Perhaps more importantly, we would like to explore payment strategies that will allow non-pharmacological interventions to be used more widely in clinical practice.

Citation:

Maust DT, Kim H, Seyfried LS, et al. Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm. JAMA Psychiatry. Published online March 18, 2015. doi:10.1001/jamapsychiatry.2014.3018.

 

MedicalResearch.com Interview with:, & Donovan Maust, MD, MS (2015). Antipsychotic Medications Linked To Higher Mortality In Dementia Patients 

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Last Updated on March 18, 2015 by Marie Benz MD FAAD

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