Antipsychotic Agent

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Contents

More Specific Terms

Classification

  • traditional
  • atypical

Indications

Contraindications

Benefit/risk

Pharmacokinetics

Adverse-effects

  • common side effects
  • long term usage
  • generally irreversible
  • 10-20% of patients

Notes

  • atypical antipsychotics may not be more effective than older agents in the treatment of schizophrenia
  • all agents are discontinued more frequently than not [4]
  • over-prescribed in nursing home setting [5]
  • variation in presribing patterns in nursing homes [10]
  • attempt to reduce antipsychotic use should be accompanied by non-pharmacologic measures (i.e. increased social interactions) otherwise neuropsychiatric deterioration may occur [19]

More General Terms

Additional Terms

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1147
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 712
  3. Sultzer, D. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. Lieberman JA et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005 Sep 22; 353:1209-23. PMID: [1]
    - Prescriber's Letter 12(9): 2005 Role of atypical antipsychotics in treating patients with Schizophrenia: Are they better than older agents? Detail-Document#: [2] (subscription needed) [3]
  5. Briesacher BA et al. Antipsychotic use among nursing home residents. JAMA 2013 Feb 6; 309:440. PMID: [4]
  6. Choosing Wisely. American Psychiatric Association Five Things Physicians and Patients Should Question. [5]
  7. First DataBank (FDB)
  8. Prescriber's Letter 15(12): 2008 Common Oral Medications that May Need Tapering Detail-Document#: [6] (subscription needed) [7]
  9. Declercq T, Petrovic M, Azermai M, et al. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2013 Mar 28;3:CD007726 PMID: [8]
  10. Chen Y, Briesacher BA, Field TS, Tjia J, Lau DT, Gurwitz JH. Unexplained variation across US nursing homes in antipsychotic prescribing rates. Arch Intern Med. 2010 Jan 11;170(1):89-95 PMID: [9]
  11. Kamble P, Chen H, Sherer JT, Aparasu RR. Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs Aging. 2009;26(6):483-92. PMID: [10]
  12. Lester P, Kohen I, Stefanacci RG, Feuerman M. Antipsychotic drug use since the FDA black box warning: survey of nursing home policies. J Am Med Dir Assoc. 2011 Oct;12(8):573-7. PMID: [11]
  13. Weeke P et al. Antipsychotics and associated risk of out-of-hospital cardiac arrest. Clin Pharmacol Ther 2014 Jun 24 PMID: [12]
  14. Marston L et al. Prescribing of antipsychotics in UK primary care: A cohort study. BMJ Open 2014 Dec 18; 4:e006135 <PubMed> PMID: [13] <Internet> [14]
  15. Maust DT, Kim HM, Seyfried LS et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: Number needed to harm. JAMA Psychiatry 2015;72(5):438-445. Mar 18; PMID: [15]
  16. FDA MedWatch Feb 22, 2011 Antipsychotic drugs: Class Labeling Change - Treatment During Pregnancy and Potential Risk to Newborns [16]
  17. Vigod SN et al Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study. BMJ 2015;350:h2298 <PubMed> PMID: [17] <Internet> [18]
  18. Sheehan R et al Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ 2015;351:h4326 <PubMed> PMID: [19] <Internet> [20]
  19. Ballard C et al. Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: A factorial cluster-randomized controlled trial by the Well-Being and Health for People with Dementia (WHELD) program. Am J Psychiatry 2015 Nov 20; PMID: [21]
  20. Herzig SJ, Rothberg MB, Guess JR et al Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors. J Am Geriatr Soc. 2016 Feb;64(2):299-305. PMID: [22]
  21. Weintraub D et al. Association of antipsychotic use with mortality risk in patients with Parkinson disease. JAMA Neurol 2016 Mar 21 PMID: [23]
  22. Huybrechts KF et al Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations. JAMA Psychiatry. Published online August 17, 2016 <PubMed> PMID: [24] <Internet> [25]
    - Wisner KL et al Use of Antipsychotics During PregnancyPregnant Women Get Sick
    - Sick Women Get Pregnant. JAMA Psychiatry. Published online August 17, 2016 <PubMed> PMID: [26] <Internet> [27]
  23. Agency for Healthcare Research and Quality (AHRQ) First- and Second-Generation Antipsychotics in Children and Young Adults: Systematic Review Update. Executive Summary - March 16, 2017 [28]

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