Tuesday, February 7, 2006

More on atypical antipsychotics in dementia & "Beware the coercive orthodoxy of dying and mourning..."

The current Journal of the American Geriatrics Society has a review on the safety and efficacy of long-term atypical antipsychotic use for behavioral and psychiatric symptoms in advanced dementia.  Verdict:  1) there's only decent data for olanzapine and risperidone being efficacious (ie, there's not very much advocating quetiapine and aripiprazole), 2) risperidone and haloperidol seem to be equally efficacious in good quality head to head trials, 3) evidence that atypicals offer benefits side-effect wise over typicals is scant, and 4) yes vascular events and mortality are higher for atypicals compared to placebo.  Note that this study was more of a systematic, narrative review (not a metaanalysis) so no 'new' information is being presented here.  That, actually, is the article's strength: it's a clear and comprehensive assessment of some very confusing research, and is arranged in clinically meaningful sections (like "What Is the Relative Effectiveness and Safety of the Atypical Antipsychotics Compared with Each Other?" and "Are the Atypical Antipsychotics More Effective or Safer than the 'Typical' Antipsychotics?").  I appreciate that. 

(See these previous posts for more on this topic.)

Also presented in this issue--there's a new tool to look at the appropriateness of pain med prescription in nursing homes; nursing home residents with aspiration pneumonia causing hospitalization had a mortality of nearly 30% in a cohort in Alberta, Canada!; and--surprise!-- pneumonia is a common pre-terminal event in patients with advanced dementia (>50% will have pneumonia within 30 days of dying).

"Beware the coercive orthodoxy of dying and mourning..."  A good quote from some of the comments about Christian's post on heparin (OK--most of the comments are from Christian and me, but the eloquent quotations and most reasoned discussion points aren't).  Nevertheless, these are the sorts of gems we'd all be treated to more of if Pallimed's readers would leave comments...

See you at AAHPM!

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