Treatment Online

NEJM report on Conventional Anti-Psychotic medications in the elderly!
> 12/1/2005 8:27:30 AM

The NEJM published a study by Philip S. Wang M.D. et al that looked at Conventional Antipsychotics after an FDA warning that was previously released warning about Atypical Antipsychotics causing a greater risk of mortality in the elderly. Their findings need to confirmed but at a minimum they indicate that conventional antipsychotics are:
"Conventional antipsychotic medications were associatedwith a significantly higher adjusted risk of death than wereatypical antipsychotic medications at all intervals studied( $≤$ 180 days: relative risk, 1.37; 95 percent confidence interval,1.27 to 1.49; <40 days: relative risk, 1.56; 95 percent confidenceinterval, 1.37 to 1.78; 40 to 79 days: relative risk, 1.37;95 percent confidence interval, 1.19 to 1.59; and 80 to 180days: relative risk, 1.27; 95 percent confidence interval, 1.14to 1.41) and in all subgroups defined according to the presenceor absence of dementia or nursing home residency.'

These finding are critical because they highlight the fact that the FDA warning about Atypical Antipsychotics was a half truth and needed to be more thorough on a subject that effects millions of elderly patients.

The other side of this issue is that elderly patients, especially those in nursing homes, are routinely overmedicated and the addition of antipsychotics to any regimen of already existing drugs needs the expert opinion of a psychiatrist. These drugs and their dosages should be titrated for effect rather than started at a conventional dosage which in the elderly is often too high for their metabolic status.

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