Tuesday, March 6, 2012

Use of antipsychotics in patients with dementia and risk of death

Antipsychotic medications are widely used in dementia to control behavioral symptoms. Many studies noted a relationship between increased risk of death among dementia patients and the use of antipsychotics. However, most patients experience difficult to manage behavioral symptoms in dementia and the death may be due to the disease process itself.  

Study published in American journal of psychiatry looked into the mortality among dementia patients who are treated with various anti-psychotic medications. This study compared differences between deaths rates in different anti psychotics using historical data.

According to this study Haloperidol (Haldol) is associated with most number of deaths. Quetiapine (Seroquel) is associated with lowest death rates. Other antipsychotics such as Risperdal, and Zyprexa, lay in-between.

Analysis of this study

However, there is a caveat in this study. It is that this study used archived data. In these data most people with severe dementia were given haloperidol, because some clinicians believed that Haldol is more effective in controlling behavioral symptoms than other antipsychotics. Therefore, naturally they used Haldol frequently in patients with more severe dementia. These patients have high death rates even without any antipsychotics. Therefore, this study may be biased toward newer anti psychotics.

In addition, we need to understand that there are very strong pharmaceutical companies to promote newer antipsychotics. Nobody promotes older antipsychotics such as Haldol even though they are preferable in certain patients.

Journal article in American journal of Psychiatry

First published in
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About Dr. Manura Nanayakkara

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Dr. Manura Nanayakkara is a Medical doctor working in Sri Lanka. He graduated from the Faculty of Medicine University of Colombo in 2005. In addition to his undergraduate medical degree, he holds a Postgraduate Diploma in Psychiatry. He completed his postgraduate degree in 2011. 

Work Experience

He started to work as a medical internist in the District general Hospital Nawalapitiya in the Kandy district (central Sri Lanka) in 2006. Following his basic training, he started to work in a Rural hospital in Akuressa (Southern part of Sri Lanka). During that period he used to treat wide variety of diseases in this rural community.

Due to his interest in the field of Psychiatry, he entered into the Diploma in Psychiatry course conducted by the Postgraduate Institute of Medicine, University of Colombo. It is the only Postgraduate medical institute in Sri Lanka.

Currently he is undergoing training in MD psychiatry program leading to specialist in the field of psychiatry.