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Kirkham J, Sherman C, Velkers C, Maxwell C, Gill S, Rochon P, Seitz D. Antipsychotic Use in Dementia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:170-181. [PMID: 28212496 PMCID: PMC5317021 DOI: 10.1177/0706743716673321] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.
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Affiliation(s)
- Julia Kirkham
- Department of Psychiatry, Queen’s University, Kingston, Ontario
| | - Chelsea Sherman
- Department of Psychiatry, Queen’s University, Kingston, Ontario
| | - Clive Velkers
- Department of Psychiatry, Queen’s University, Kingston, Ontario
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario
| | - Sudeep Gill
- Division of Geriatric Medicine, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Paula Rochon
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario
| | - Dallas Seitz
- Department of Psychiatry, Queen’s University, Kingston, Ontario
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Caddell LS, Clare L. A profile of identity in early-stage dementia and a comparison with healthy older people. Aging Ment Health 2013; 17:319-27. [PMID: 23171274 DOI: 10.1080/13607863.2012.742489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of the study was to determine whether people in the early stages of dementia experience their sense of identity differently to healthy older people and to examine whether different aspects of identity are related to each other in each group. This was a cross-sectional questionnaire-based study; 50 people with early-stage dementia and 50 age-matched people without dementia completed measures pertaining to different aspects of identity. Measures of mood and self-esteem were also included so that any differences could be taken into account in the analysis. There were very few differences in identity between the groups. After differences in levels of anxiety were accounted for, there were no differences in scores on most measures of identity. However, people in the early stages of dementia scored significantly lower on one subtotal for one measure of identity, whereas healthy older adults reported significantly more identity-related distress than people in the early stages of dementia. For both groups, there were no associations between different aspects of identity. People in the early stages of dementia do not differ much from healthy older adults in terms of their identity. Since healthy older people experience more distress relating to identity, they may be more likely to benefit from some sort of intervention than people in the early stages of dementia. It might be useful to consider identity as consisting of multiple components in future studies, rather than assuming that one aspect of identity represents the overall experience of identity.
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Affiliation(s)
- Lisa S Caddell
- Spectrum Centre for Mental Health Research, Lancaster University, Lancashire, United Kingdom.
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Psychotropic prescribing in the oldest old attending a geriatric psychiatry service: a retrospective, cross-sectional study. Ir J Psychol Med 2013; 30:187-196. [PMID: 30189496 DOI: 10.1017/ipm.2013.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE More people are living beyond their 90s, yet this group has not been much studied. This study aimed to describe a sample of non-agenarians and centerians attending an old age psychiatry service with a focus on pharmacotherapy. METHODS Retrospective, cross-sectional survey of patients aged >90 in contact with the Department of Old Age Psychiatry in a university hospital over a 1-year period. Results were compared with the Beers, the Canadian and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. RESULTS A total of 65 nonagenarians or centerians were identified (mean age 93, 82% female). The majority (65%) resided in a nursing home; dementia was the most common diagnosis (77%), followed by depression (29%). The most commonly prescribed psychotropics were antidepressants (58%), followed by antipsychotics (45%), hypnotics (42%), anti-dementia agents (31%) and anxiolytics (26%). Overall, patients were on a mean of 2.1 (S.D. 1.3, range 0-5) psychotropics and 4.99 (S.D. 2.7, range 0-11) non-psychotropics. Mean Mini Mental State Examination (MMSE) score was 15 (S.D. 8.1). Increasing anticholinergic burden was negatively associated with MMSE scores (B = -1.72, p = 0.013). Residing in a nursing home was associated with a higher rate of antidepressant [OR 5.71 (95% CI 1.9-17.4)], anxiolytic [OR 13.5 (95% CI 1.7-110.4)] and antipsychotic [OR 3.4 (95% CI 1.1-10.4)] use. Potentially inappropriate prescribing included long-term benzodiazepine use (26%) and long-term antipsychotic use (25%). CONCLUSIONS Our sample had a high psychiatric morbidity burden with high levels of psychotropic use. Ongoing review and audit of psychotropic use in elderly patients can identify potentially inappropriate prescribing in a group vulnerable to high levels of polypharmacy and extended psychotropic use.
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Östling S, Bäckman K, Waern M, Marlow T, Braam AW, Fichter M, Lawlor BA, Lobos A, Reischies FM, Copeland JRM, Skoog I. Paranoid symptoms and hallucinations among the older people in Western Europe. Int J Geriatr Psychiatry 2013; 28:573-9. [PMID: 22911450 DOI: 10.1002/gps.3861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 06/25/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE It is not clear whether the prevalence of psychosis increases with age. We studied the age-specific prevalence of psychotic symptoms in older people in Western Europe. METHODS Older people without dementia (age 65-104 years, N = 8762) from the western part of Europe in the EURODEP concerted action took part in psychiatric examinations. RESULTS In total, 2.4% of the men and 2.9% of the women had psychotic symptoms. Using a multilevel logistic regression model that included gender and age as a continuous variable, we found that a 5-year increase in age increased the prevalence of psychotic symptoms (odds ratio 1.2 95% confidence interval 1.06-1.3, p = 0.001). A second multilevel regression model showed that wishing to be dead, depressed mood, functional disability, not being married and cognitive impairment measured with Mini mental state examination were all associated with psychotic symptoms whereas gender was not. CONCLUSION The prevalence of psychotic symptoms in non-demented older people increases with age, and these symptoms are associated with other psychopathology, social isolation and problems with daily living.
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Affiliation(s)
- Svante Östling
- Institute of Neuroscience and Physiology, Psychiatry Section, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sonnenberg CM, Bierman EJM, Deeg DJH, Comijs HC, van Tilburg W, Beekman ATF. Ten-year trends in benzodiazepine use in the Dutch population. Soc Psychiatry Psychiatr Epidemiol 2012; 47:293-301. [PMID: 21258999 PMCID: PMC3259393 DOI: 10.1007/s00127-011-0344-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 01/06/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the past decades knowledge on adequate treatment of affective disorders and awareness of the negative consequences of long-term benzodiazepine use increased. Therefore, a decrease in benzodiazepine use is expected, particularly in prolonged use. The aim of this study was to assess time trends in benzodiazepine use. METHODS AND MATERIAL Data from the Longitudinal Aging Study Amsterdam (LASA) were used to investigate trends in benzodiazepine use between 1992 and 2002 in two population-based samples aged 55-64 years. Differences between the two samples with respect to benzodiazepine use and to sociodemographic, physical health and mental health characteristics were described and tested with chi-square tests and logistic regression analyses. RESULTS Benzodiazepine use remained stable over 10 years, with 7.8% in LASA-1 (n = 874) and 7.9% in LASA-2 (n = 919) (p = 0.90) with a persisting preponderance in women and in people with low education, low income, chronic physical diseases, functional limitations, cognitive impairment, depression, anxiety complaints, sleep problems and when using antidepressants. Long-term use remained high with 70% in 1992 and 80% in 2002 of total benzodiazepine use. CONCLUSION In the Dutch population aged 55-64, overall benzodiazepine use remained stable from 1992 to 2002, with a high proportion of long-term users, despite the effort to reduce benzodiazepine use and the renewal of the guidelines. More effort should be made to decrease prolonged benzodiazepine use in this middle-aged group, because of the increasing risks with ageing.
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Affiliation(s)
- Caroline M. Sonnenberg
- Department of Psychiatry of the VU Medical Centre, The Institute for Research in Extramural Medicine (EMGO) of the Vrije Universiteit Medical Centre, Valeriusplein 14, 1075 BH Amsterdam, The Netherlands
| | - Ellis J. M. Bierman
- Department of Psychiatry of the VU Medical Centre, The Institute for Research in Extramural Medicine (EMGO) of the Vrije Universiteit Medical Centre, Valeriusplein 14, 1075 BH Amsterdam, The Netherlands
| | - Dorly J. H. Deeg
- Department of Psychiatry of the VU Medical Centre, The Institute for Research in Extramural Medicine (EMGO) of the Vrije Universiteit Medical Centre, Valeriusplein 14, 1075 BH Amsterdam, The Netherlands
| | - Hannie C. Comijs
- Department of Psychiatry of the VU Medical Centre, The Institute for Research in Extramural Medicine (EMGO) of the Vrije Universiteit Medical Centre, Valeriusplein 14, 1075 BH Amsterdam, The Netherlands
| | - Willem van Tilburg
- Department of Psychiatry of the VU Medical Centre, The Institute for Research in Extramural Medicine (EMGO) of the Vrije Universiteit Medical Centre, Valeriusplein 14, 1075 BH Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry of the VU Medical Centre, The Institute for Research in Extramural Medicine (EMGO) of the Vrije Universiteit Medical Centre, Valeriusplein 14, 1075 BH Amsterdam, The Netherlands
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Psychotropic drug use in relation to mental disorders and institutionalization among 95-year-olds: a population-based study. Int Psychogeriatr 2011; 23:1270-7. [PMID: 21447258 DOI: 10.1017/s1041610211000524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prevalence of psychotropic drug use is high among the elderly, but research on how psychotropic drugs are used among individuals aged 90 years and older is limited. An increased knowledge on this topic may contribute to improved prescribing patterns in this vulnerable population. The aim of this study was to assess the use of psychotropic drugs in relation to mental disorders and institutionalization among 95-year-olds and to identify use of potentially inappropriate psychotropic drugs. METHODS All 95-year-olds born in 1901-1903 living in nursing homes or community settings in Gothenburg, Sweden were invited to participate. The response rate was 65% and 338 95-year-olds were examined (263 women, 75 men). Psychotropic drug use in relation to mental disorders and institutionalization was assessed. Information on drug use was collected primarily from multi-dose drug dispensing lists. Participants were examined by trained psychiatrists using the Comprehensive Psychopathological Rating Scale and a battery of cognitive tests. Dementia, depression, anxiety and psychotic disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R). RESULTS Sixty percent of the 95-year-old participants used psychotropic drugs; hypnotics were most common (44%). Potentially inappropriate psychotropics were observed in one third (33%). Antidepressants were used by 7% of the participants without dementia who fulfilled criteria for a depressive disorder, while 56% used hypnotics and 30% used anxiolytics. CONCLUSIONS The high prevalence of psychotropic drug use and the nonspecific nature of these treatments among 95-year-olds indicate a need for improvement in prescribing patterns.
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Abstract
OBJECTIVE To determine the 1-month prevalence of mental disorders among 95-year olds. DESIGN Cross-sectional population sample of 95-year olds. SETTING : All 95-year olds born in the period 1901-1903 living in Gothenburg, Sweden, were invited. Elderly living in both community settings and nursing homes were included. PARTICIPANTS In total, 338 95-year olds (response rate: 65%) were examined (263 women, 75 men). MEASUREMENTS All participants were examined by psychiatrists using the Comprehensive Psychopathological Rating Scale and cognitive tests. Mental disorders were classified according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria. RESULTS Two-third of all 95-year olds had a mental disorder. In the total sample of 95-year olds, the 1-month prevalence was 52% for dementia, 8% for depression, 4% for anxiety, and 3% for psychotic disorders. Almost one-third (29%) of the nondemented 95-year olds fulfilled criteria for a psychiatric disorder: 17% had depression, 9% anxiety, and 7% psychotic disorder. CONCLUSIONS The combined prevalence of mental disorders was high among 95-year olds, even after excluding dementia. These findings emphasize the importance of research, care, and detection of psychiatric problems in this age group.
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Alonso Formento E, Saz Muñoz P, Lobo Satué A, Ventura Faci T, De La Cámara Izquierdo C, Marcos Aragüés G. [Association between anxiolytic and antidepressant consumption and psychiatric symptoms in the elderly]. Rev Esp Geriatr Gerontol 2010; 45:10-14. [PMID: 20044171 DOI: 10.1016/j.regg.2009.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 08/30/2009] [Accepted: 09/04/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Many studies have reported excessive consumption of psychotropic drugs in the elderly but none have related psychotropic drug use to psychiatric symptoms and sleep disorders in community-dwelling patients aged more than 65 years old in Spain. MATERIAL AND METHODS We performed a cross sectional study in a representative sample (9,739 persons) from the population aged more than 55 years old in the city of Zaragoza in 2001. A total of 3,714 persons aged more than 65 years old were interviewed. The data belonged to the ZARADEMP project. RESULTS The mean age of the sample was 76.9 years (59.2% women and 40.8% men). Anxiolytics or antidepressants were consumed by 22.6% of the sample. A diagnosis of depression was made in 12.9%, anxiety in 1.6% and insomnia in 36%. We found high consumption of anxiolytics, especially in persons with depression (42.2%) and low consumption of antidepressants, especially in persons with a diagnosis of depression (15.4%) and in those with depressive symptoms (8.2%). CONCLUSIONS A correct psychiatric diagnosis is essential before psychotropic drugs are used to ensure appropriate treatment of the elderly with psychiatric symptoms.
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Abstract
OBJECTIVE To examine the 1-year prevalence of psychotic symptoms and schizophrenia in nondemented 95-year-olds, and to examine the relation between psychotic symptoms and other psychiatric symptoms, sensory impairments, and cognitive functioning. PARTICIPANTS The representative sample was 95-year-olds living in Göteborg, Sweden (N = 338). Individuals with dementia were excluded (N = 175), leaving 163 subjects for this study. DESIGN This was a cross-sectional population study, including psychiatric and physical examinations, cognitive tests, and interviews with close informants. MEASUREMENTS Diagnosis of schizophrenia, psychotic symptoms, paranoid ideation and dementia according to Diagnostic and Statistical Manual of Mental Disorders, Third Revision (DSM-III) were measured. Cognitive function was tested with the Mini-Mental State Exam. Other psychiatric symptoms were measured by the Comprehensive Psychopathological Rating Scale. RESULTS The one-year prevalence of any psychotic symptom was 7.4% (95% confidence interval [CI] 3.8-12.5); including hallucinations 6.7% (95% CI 3.4-11.8) and delusions 0.6% (95% CI 0.0-3.4). Four (2.4%) individuals fulfilled DSM-III-R criteria for schizophrenia. Individuals with psychotic symptoms or paranoid ideation did not differ regarding cognitive functioning compared with individuals without these symptoms. Individuals with hallucinations and paranoid ideation had an increased frequency of previous paranoid personality traits compared with individuals without psychotic symptoms and paranoid ideation. No individuals with psychotic symptoms had a formal thought disorder, incoherence of speech, or flat affect. CONCLUSION The authors found a high prevalence of psychotic symptoms, paranoid ideation, and schizophrenia in the very old. Most of the symptoms were elucidated by information from key informants, illustrating the importance of including relatives in the evaluation of elderly persons.
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Alanen HM, Finne-Soveri H, Noro A, Leinonen E. Use of antipsychotics among nonagenarian residents in long-term institutional care in Finland. Age Ageing 2006; 35:508-13. [PMID: 16807310 DOI: 10.1093/ageing/afl065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a paucity of information about the use of antipsychotic medication in long-term care, especially among the oldest-old residents. OBJECTIVE To analyse the factors associated with the use of antipsychotic medication among nonagenarian residents in long-term institutional care. DESIGN A retrospective study was designed from cross-sectional data, gathered in the period 1 January 2003 to 30 June 2003, in Finland. Data were extracted from the Resident Assessment Instrument database, based on Minimum Data Set 2.0 assessments. SETTING Data were provided by 23 hospital-based institutions and 43 residential homes. SUBJECTS Residents aged >or=90 years were included, consisting of 1,334 resident assessments. RESULTS Almost a third of the residents received one or more antipsychotic medication. In the logistic regression analysis, factors associated with the use of antipsychotics among nonagenarian residents were as follows: socially inappropriate or disruptive behavioural symptoms [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.36-2.54], concomitant anxiolytic medication (OR 1.83, 95% CI 1.39-2.42), recurring anxious complaints (OR 1.61, 95% CI 1.17-2.22), recurring physical movements (OR 1.43, 95% CI 1.08-1.91) and unsettled relationships (OR 1.35, 95% CI 1.15-1.57). A good sense of initiative or involvement was significantly less likely to be associated with antipsychotics (OR 0.86, 95% CI 0.80-0.94). There were no associations between any psychiatric diagnoses or symptoms and the use of antipsychotics. CONCLUSIONS Antipsychotic medication use in nonagenarians in long-term institutions was common and seemed in many cases to be associated with residents' negative attitudes to others. Querulous residents received antipsychotics more commonly than those with good social skills. Clearly defined indications may not be fulfilled in many cases, and an evaluation of treatment may be lacking. These may indicate that in Finland, there could be a considerable gap between antipsychotic medication recommendations and actual clinical practice.
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Affiliation(s)
- Hanna-Mari Alanen
- University of Tampere Medical School, University of Tampere, FIN-33014 Tampere, Finland.
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Riedel-Heller SG, Busse A, Angermeyer MC. The state of mental health in old-age across the 'old' European Union-- a systematic review. Acta Psychiatr Scand 2006; 113:388-401. [PMID: 16603030 DOI: 10.1111/j.1600-0447.2005.00632.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The paper provides the first syllabus on the prevalence of mental disorders in old-age focusing on surveys conducted in the 15 countries, which comprised the 'old' European Union. METHOD A systematic search of the literature published from 1990 onwards was conducted. RESULTS Mental disorders in old-age are common. The most serious threats to mental health in old-age are posed by dementia and depression. It is a clear cut finding that dementia exponentially increases with age. The basic issue of whether depression increases or decreases with age remains unsolved. Databases on substance use, mild cognitive impairment, psychotic syndromes, anxiety, and somatoform disorders in old-age are much smaller, making conclusions difficult to draw. CONCLUSION Numerous questions in the field remain to be answered. Concerted action is needed to produce comparable data across Europe.
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Psychotic symptoms in the elderly. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/bf02629403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Giron MS, Forsell Y, Bernsten C, Thorslund M, Winblad B, Fastbom J. Psychotropic drug use in elderly people with and without dementia. Int J Geriatr Psychiatry 2001; 16:900-6. [PMID: 11571771 DOI: 10.1002/gps.438] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the prevalence of psychotropic drug use in very old persons with and without dementia in two time periods, and describe the patterns of psychotropic drug use between institutions and non-institutions. METHODS Descriptive analysis on a sample of subjects aged 81+ from a population-based study in Stockholm, Sweden. Psychotropic drug use data were collected from the 1987-1989 and 1994-1996 periods of the study. The diagnosis of dementia was based on the DSM III-R. RESULTS About 41% of the subjects used at least one psychotropic drug in both periods. Women and subjects in institutions more commonly used psychotropic drugs. The most commonly reported were, in rank order, hypnotics-sedatives, anxiolytics, antipsychotics and antidepressants. Hypnotics-sedatives and anxiolytics were the most commonly used in both institutions and non-institutions. More persons with dementia used psychotropic drugs in both periods. The use of newer drugs, for example, SSRI, was evident. Multivariate analyses showed increased risk for psychotropic drug use among subjects in institutions. CONCLUSIONS This study confirms the high rate of psychotropic drug use in the very old, particularly in persons with dementia. Psychotropic drug use was high among subjects living in institutions.
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Affiliation(s)
- M S Giron
- Division of Geriatric Medicine, NEUROTEC, Karolinska Institute, Stockholm, Sweden.
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Abstract
Functional brain imaging has provided unique and exciting opportunities to strengthen our knowledge of the biologic substrate of the aging brain and neuropsychiatric disorders. Positron emission tomography (PET) is a particularly powerful tool for quantifying the neurobiologic correlates of cognition, mood, and behavior. Initial PET studies of aging, psychiatric disorders, and neurodegenerative disease focused primarily on generalized physiologic parameters such as cerebral blood flow and metabolism, and early neuroreceptor imaging studies relied on relatively nonselective markers. New, selective receptor radioligands now offer a previously inaccessible means to investigate the dynamic relationships among neurochemistry, aging, and psychopathology in vivo. This approach has substantial advantages over peripheral (platelet and cerebrospinal fluid) markers, neuroendocrine challenge studies, animal models, and postmortem receptor binding assays. Advances in tracer kinetic modeling, magnetic resonance imaging facilitated PET image analysis, radiochemistry techniques, instrumentation, and image processing have helped pave the way for increased emphasis on functional imaging studies of neuropsychiatric disorders. The capability to correct PET image data for the confounding effect of cerebral atrophy permits relationships among age-related brain changes and neurobiologic disease mechanisms to be more accurately examined in the elderly.
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Affiliation(s)
- C C Meltzer
- Department of Radiology, University of Pittsburgh, Pennsylvania, USA
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