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• Understand the incidence and risks of tardive
dyskinesia with atypical and conventional antipsychotic therapies in older patients.
metabolic side effects from prescribed antipsychotics therapies in older patients.
• Evaluate potential risks of falls, DM and other
side effects in older patients requiring psycho-active therapies.
– management of psychosis– Brief psychotic disorders due to a general medical
– Management of psychosis– Schizophrenia– Dementia related psychosis– Bipolar disorder– Psychosis related to Parkinson’s disease
• Drug induced movement disorder.
• Involuntary choreatic movements that may
appear days and months after the introduction of continuous use of AP1.
• Associated with drugs that block dopamine
receptors (neuroleptics) or central dopaminergic transmission.
– N/V (prochlorperazine)– GI disorders (metoclopramide)
Jesic MP. et al. Med Pregl
– 17% - 18% of dementia patients to atypical
Cumulative incidence of definitive TD in
older patients with borderline dyskinesiaa
• Excessive weight gain.
• Glucose intolerance.
• New-onset type 2 diabetes.
• Diabetic ketoacidosis (DKA).
• Huybrechts KF. et al. assessed the risk of
mortality associated with the use of individual antipsychotic drugs in elderly residents in nursing homes.
– 75,445 new users; 2001-2005; ≥ 65 y/o; 180 days.
• haloperidol users had an increased risk of mortality.
• Quetiapine users had a decreased risk of mortality.
• Transdermal absorption delayed, especially
• Hepatic drug metabolism may see age related
• Renal elimination typically declines with age.
Cusack BJ. Am J Geriatr Pharmacother. 2004
• Aparasu et al. – community dwelling elderly
– 1996-2004 Medical Expenditure Panel Survey.
– Examined the impact of typical to atypical
– Analytical study sample N=124; mean age 74.37
– Conclusion – typical antipsychotics associated
with increased risk of hospitalizations.
Weight gain Risk for diabetes Worsening lipid profile
+ = increase effect, - = no effect, D = discrpant results. Adapted from: J consensus Development
Conference on Antipsychotic Drugs and Obesity and Diabetes. J Clin Psychiatr. 2004;65:267-272.A14
a = newer drugs with limited long-term data
Jin H. et.al. Schizophrenia Research; 2004
Anticholineric Orthostasis Weight Gain Prolactin
EPS, extrapyramidal side effect; relative side-effect risk: +/-, negligible; =, low; ++, moderate; +++, moderately high; ++++, high.
Crismon L. Argo TR. Buckley PF. Chapter 76 Schizophrenia
• Chatterjee S. et al. evaluated the risk of falls
and fractures associated with the use of risperidone, olanzapine and quetiapine.
– 12, 145; ≥ 50y/o; 2000 – 2008; data from IMS
• Gill SS. et al. – compared the incidence of
admissions to the hospital for stroke in older adults receiving atypical and typical antipsychotics (AP).
– N = 32,710 patients with dementia (17,845 had
been dispensed an atypical AP and 14,865 had been dispensed a typical AP; ≥ 65 y/o; Canadians.
• Jalbert JJ. et al. – study to quantify the
association between AP use and the risk of diabetes onset among NH residents with dementia.
– N = 29,203 long stay Medicaid residents in CA, FL,
Il, NY and Ohio; 1/2001 – 12/2002; ≥ 65 y/o.
– Conclusions – typical AP were associated with an
increase risk of developing diabetes. Atypical AP were not associated with an increase in risk of developing diabetes.
Slattum PW, Swerdlow RH, Hill AM. Chapter 63. Alzheimer's Disease. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach
. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?aID=7984697. Accessed May 7, 2013
Kohen I. Lester PE. Lam S. Antipsychotic treatments for the elderly. Neuropsychiatr Dis and Treatment.
Woods SW. Morgenstern H. Saksa JR. et.al. Incidence of tardive dyskinesia with atypical and conventional antipsychotic medications. J Clin Psychiatr
Olanow CW, Schapira AH. Chapter 372. Parkinson's Disease and Other Movement Disorders. In: Fauci AS, Kasper DL, Jameson JL, Longo DL, Hauser SL, eds. Harrison's Principles of Internal Medicine
. 18th ed. New York: McGraw-Hill; 2012. http://www.accesspharmacy.com/content.aspx?aID=9146448. Accessed May 7, 2013. http://www.accesspharmacy.com/content.aspx?aID=7987911. Accessed May 7, 2013.
6. Jesić MP. Jesić A. Filipović JB. Zivanović O. Extrapyramidal syndromes caused by
antipsychotics. Med Pregl
. 2012 Nov-Dec;65(11-12);521-6.
7. Jin H. Meyer JM. Jeste CV. Atypical antipsychotics and glucose dysregulation.
8. Cusack Bj. Pharmacokinetics in older persons. Am J Geriatri Pharmacother.
9. Crismon L. Argo TR. Buckley PF. Chapter 76 Schizophrenia. In: Talbert RL, DiPiro JT.
Matzke GR. et.al. eds. Pharmacotherapy
. 8th ed. NY: McGraw-Hill;2011. http://www.accesspharmacy.com/content.aspx?alD=7987911. Accessed May 7, 2013.
10. Aparasu RR. Jano E. Johnson ML. Chen H. Hospitalization risk associated with
typical and atypical antipsychotic use in community-dwelling elderly patients. Am J Geriatri Pharmacother.
11. Touré JT. Brandt NJ. Limcanco MR. Briesacher BA. Impact of second-generation
antipsychotics on the use of antiparkison agents in nursing homes and assisted-living facilities. Am J Geriatri Pharmacother.
. 2006 Mar;4(1):25-35.
12. Huybrechts FK. Gerhard T. Crystal S. et al. Differential risk of death in older
residents in nursing homes prescribed specific antipsychotic drugs. BMJ.
13. Chatterjee S. Chen H. Johnson ML. Aparasau RR. Risk of falls and fractures in older
adults using atypical antipsychotic agents. Am J Geriatr Pharmacother.
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