Antipsychotics and older people - new evidence on health risks

There has been much criticism in the past about the overuse of newer, atypical antipsychotic drugs to manage problem behaviour in elderly people with dementia. However, a new study by researchers from Brigham and Women's Hospital in Boston has suggested that alternative drugs may be just as dangerous. The researchers studied 10,900 people who were admitted to nursing homes in British Columbia between 1996 and 2006 and who received a psychotropic drug within 90 days of admission. The study found that people taking conventional antipsychotics, antidepressants and benzodiazepines were at higher risk of death and fractures of the femur. Levels of pneumonia and heart failure did not differ between those taking atypical antipsychotics and those taking other drugs.

Heart risks of antipsychotics start early

Even a short time taking antipsychotic drugs can increase people's risk for heart disease. Researchers from the University of Melbourne reviewed 25 previous studies which tracked risk factors such as high blood pressure, cholesterol levels and body weight of people taking older or newer antipsychotics. Before taking the drugs about 40% of the patients were overweight but after six months 60% were. The patients had gained weight after one month on the drugs and had increases in their cholesterol levels after three or four months. As well as treating people with schizophrenia the drugs are also given to people suffering from bipolar disorder, personality disorders and anxiety.

Less use of 'chemical cosh' for dementia patients

Elderly people in the U.S. are being prescribed fewer antipsychotics - which can have side effects including an increased risk of stroke, weight gain and diabetes - to manage their behaviour. The change comes after the Food and Drug Administration issued a 'black-box warning' about using the drugs in this way. Researchers from the University of Michigan in Ann Arbor analyzed data on more than 250,000 veterans from the national Veterans Affairs registers. They found that the overall use of antipsychotics in elderly dementia patients fell from nearly 18% in 1999 to 12% in 2007.

Antipsychotics and diabetes

More people are being prescribed antipsychotic drugs these days and more people are developing type 2 diabetes. But is there a link between taking antipsychotic medication and developing diabetes? So far the evidence is unclear but a team of researchers from the University of Copenhagen studied 1,772,425 people (about a third of the total Danish population) in an attempt to find out. 345,937 people had been prescribed antipsychotics and 50,739 developed diabetes over the course of the study, which ran from 1996 to 2005. Treatment with 'first-generation' antipsychotics led to a 53% increase in risk and 'second-generation' antipsychotics had a 32% increase. The incidence of diabetes increased in line with the number of prescriptions and the number of different drugs people were prescribed.

Kessing, Lars Vedel ... [et al] - Treatment with antipsychotics and the risk of diabetes in clinical practice Britsih Journal of Psychiatry October 2010, 197(4), 266-271

U.K. Government clamps down on chemical cosh for dementia

Over the years the Mental Health Update blog has featured a number of posts about the damaging effects of antipsychotic drugs prescribed as a 'chemical cosh' for people with dementia and now the U.K. Government (probably not, to be honest, influenced by this blog!) has decided to clamp down on their use. Doctors will be told to stop the over-prescribing of the drugs; something that has been linked to 1,800 premature deaths a year. 180,000 patients are prescribed the drugs each year despite the fact that they do not benefit three-quarters of the people given them and can cause strokes. The clamp down on the over use of the drugs comes as part of a dementia plan backed by £200m of funding aimed at diagnosing sufferers earlier and making sure they receive better care in hospitals and care homes.

You can read more about this story here.

Do antipsychotics rot your brain?

Post mortems have shown that people with schizophrenia have changes in their brains compared to people without the condition. A number of studies have shown that their brains are smaller, that they have less grey matter and larger ventricles (gaps) with more cerebrospinal fluid. But there is a debate as to whether these changes are due to the effects of schizophrenia or the antipsychotics used to treat it. Researchers from University College London and Lincoln Memorial University in Tennessee reviewed 26 MRI (magnetic resonance imaging) studies into this issue and found that 14 of them showed a decline in global brain or grey-matter volume over the course of drug treatment. Three studies of patients with long-term schizophrenia but who had not taken drugs showed no differences in brain volume. The researchers concluded that 'antipsychotics may contribute to the genesis of some of the abnormalities usually attributed to schizophrenia.'

Moncrieff, J. and Leo, J. - A systematic review of the effects of antipsychotic drugs on brain volume Psychological Medicine September 2010, 40(9), 1409-1422

More evidence for antipsychotic risk in older people

Despite growing evidence of side effects antipsychotic drugs (originally developed to deal with the symptoms of schizophrenia, psychois and bipolar disorder) are still prescribed to older people without these conditions. The American company Prescription Solutions studied 78,450 elderly people. None of them had schizophrenia, bipolar disorder or diabetes at the start of the study. The participants were followed for a five-year period over which time 13,075 developed diabetes. The study showed that the participants who had received at least one prescription for an antipsychotic drug had a 32% greater chance of developing diabetes.

You can find out more about this research at

http://www.medicalnewstoday.com/articles/188824.php

FDA warning reduced antipsychotic use in dementia patients

Antipsychotics are often used as a 'chemical cosh' to control behaviour problems in people with dementia. Studies have shown that this can have damaging effects on people's health and in 2005 the U.S. Food and Drug Administration (FDA) issued a warning about them. Researchers from the University of Rochester Medical Center in New York have been monitoring the prescription of antipsychotics to this group and have found that there has been a 19% fall since 2005.

You can find out more about this study at

http://uk.reuters.com/article/idUKTRE60A5DB20100111?feedType=RSS&feedName=healthNews&sp=true

Drugs and falling in older people

Researchers at the University of British Columbia have been looking into which drugs are linked to an increased number of falls in older people. They reviewed 22 studies on falls in people over 60 covering a total of 79,000 participants. They found that antidepressants had the strongest statistical link with falling but antipsychotics and benzodiazepines such as valium were also associated with an increased risk. Painkillers were found not to be linked to an increased risk of falling which is the fifth leading cause of death in the developed world.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/11/091123171410.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Antipsychotics and weight gain in children

In the U.S. antipsychotic drugs are often prescribed for children and adolescents. However, new research from the Feinstein Institute for Medical Research in New York suggests that they may - as they do in adults - lead to weight gain making more children overweight and obese and raising their risk for diabetes and heart disease. The study looked at 272 children between the ages of 4 and 19 who were followed for 11 weeks. Those taking Zyprexa gained an average of 18.7 lbs, those taking Seroquel gained 13.4 lbs, those on Risperdal gained 11.7 lbs and those on Abilify gained 9.7 lbs. Up to a third of the children became overweight or obese over the course of the 11-week study.

You can find out more about this research at

http://uk.reuters.com/article/idUKTRE59Q4Q920091027?feedType=RSS&feedName=healthNews&pageNumber=2&virtualBrandChannel=0

'Chemical cosh' still being used for Alzheimer's patients

The use of antipsychotic drugs as a 'chemical cosh' for people with Alzheimer's disease has proved very controversial and a new survey by the Alzheimer's Society suggests that it is still a problem. The survey - of over 650 nurses and 450 nurse managers - showed widespread use of the drugs, sometimes purely to control 'difficult' patients. Government guidelines say the drugs can be given if patients are severely agitated or violent but critics claim that they are overused to keep patients sedated and make life easier for staff. The drugs can have serious side effects and are known to increase the risk of death.

You can find out more about this story at

http://news.bbc.co.uk/1/hi/health/8293591.stm

Antipsychotics: new research deepens confusion

The drugs used to treat schizophrenia - known as antipsychotics - can have serious side effects. An older drug called clozapine can cause a condition called agranulocytosis - a decline in the body's number of white blood cells - which can be fatal. Partly because of this side effect clozapine has fallen out of fashion now and has been replaced by newer drugs such as quetiapine, resperidone and olanzapine. However, these drugs can be linked to an increased risk of diabetes and cardiovascular disease. A Finnish analysis of 10 years' worth of medical records covering 67,000 people by researchers at the University of Kuopio compared death rates in people taking different antipsychotic drugs. The study compared the drugs to an older 'first-generation' antipsychotic perphenazine. Clozapine was found to reduce mortality by 26% whereas quetiapine (41%), resperidone (34%) and olanzapine (13%) all increased deaths. There were no differences in death from heart disease between the different drugs but clozapine had a substantially lower risk of suicide whereas quetiapine increased the risk of people killing themselves. Clozapine is known to be more effective than other antipsychotic drugs and generic (i.e. cheaper) versions of it are now available leaving clinicians to weigh up the new research against the risk of agranulocytosis.

You can find out more about this research at

http://uk.reuters.com/article/idUKTRE56C15Z20090713?feedType=RSS&feedName=healthNews&sp=true

Antipsychotics approved by FDA panel

A panel advising the U.S. Food and Drug Administration has backed the use of antipsychotic medication for children and teenagers with schizophrenia and bipolar disorder. The panel backed the wider use of the pills but had worries about the long-term effects the drugs could have on youngsters. The drugs already have combined sales of $10 billion a year but there has been little research into their long-term effects and there were also concerns that they could be used to treat other conditions such as attention deficit hyperactivity disorder (ADHD). The drugs have the side effect of weight gain and sleepiness but these symptoms need to be weighed against the damage caused by the hallucinations and delusions of schizophrenia and the extreme mood swings of bipolar disorder.

http://uk.reuters.com/article/healthNews/idUKTRE5597IC20090611?feedType=RSS&feedName=healthNews&sp=true

Antipsychotics and Alzheimer's: more evidence of harm and ineffectiveness

Despite increasing evidence of their harmful effects antipsychotic drugs are often prescribed to elderly people with Alzheimer's disease to control their behaviour. A study of 421 outpatients with Alzheimer's disease by researchers at the University of Southern California, Los Angeles looked into the effects of antipsychotic drugs on people's weight and cholesterol levels. They found that women taking the drugs gained an average of 0.14 lbs per week and the longer they took the drugs the more likely they were to put on weight. The effect on weight was significant for olanzapine and quetiapine but less so for risperidone. Olanzapine was also significantly associated with an increased waist circumference and lowered levels of 'good' cholesterol. Men showed no significant weight gain but the drugs did not improve people's quality of life or function and did not decrease their need for care.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE53J5I820090420?feedType=RSS&feedName=healthNews

Olanzapine, aripiprazole and weight gain

Olanzapine is a drug used to treat schizophrenia. It has been associated with weight gain, insulin resistance, high cholesterol and diabetes. A study of 15 people with schizophrenia who were already taking olanzapine experimented with another drug called aripiprazole. Half the participants were given aripiprazole and half a placebo. After four weeks of aripiprazole treatment there were significant declines in weight and certain types of cholesterol. There were few side effects to adding the aripiprazole.

Henderson, David C. ... [et al] - Aripiprazole added to overweight and obese olanzapine-treated schizophrenia patients Journal of Clinical Pharmacology April 2009, 29(2), 165-169

Adverse drug reactions go unnoticed

Adverse drug reactions (ADRs) are fairly common and need to be recorded so that the same patient is not exposed again to a drug which may have caused a problem earlier. However, very little has been written about the recording of ADRs in psychiatric settings. A survey of 150 patients on acute adult and elderly wards in Oxleas NHS Trust, S.E. London found that almost two-thirds of them had experienced an ADR. For 64 patients documentation of ADRs was either inaccurate or incomplete and allergy documentation was either innacurate or absent for 81 of the patients. The severity of an allergic reaction did not seem to predict whether it would be recorded or not. The researchers concluded that the documentation of ADRs for these patients was 'below acceptable standards.'

Sohel, Jagjit, Clark, Ben S. and Paton, Carol - Allergies and adverse drug reactions: clinical records versus patients' perceptions Journal of Mental Health February 2009, 18(1), 51-56

Tardive dyskinesia and mortality

Tardive dyskinesia is one of the main side effects of antipsychotic drugs and is characterized by repetitive, involuntary and purposeless movements such as grimacing, tongue protrusion, lip smacking, rapid eye blinking and involuntary movements of the hands and feet. A study of 608 Asian people with schizophrenia compared the mortality rate in those with and without tardive dyskinesia. It found that people with tardive dyskinesia were nearly twice as likely to die over the six years of the study although the condition was not linked to any specific cause of death.

Chong, Siow-Ann ... [et al] - Mortality rates among patients with schizophrenia and tardive dyskinesia Journal of Clinical Psychopharmacology February 2009, 29(1), 5-8

Heart risk for antipsychotics

One of the main advantages of newer, 'atypical,' drugs for schizophrenia is that they are thought to have less of a risk of serious side effects such as heart attacks. However, a study of 277,000 people in Tennesee by researchers at the Vanderbilt University School of Medicine found that the newer drugs actually led to a greater risk of a heart attack than older medication. The study used files from the Tennesee Medicaid system which is aimed at providing health insurance for people on lower incomes. It found that users of the drugs had twice the rate of fatal heart attacks of non-users and the higher the dose of the drugs the greater the risk. Once patients stopped taking the drugs the risk of a heart attack faded. Although the risks may be outweighed by the benefits for people suffering from schizophrenia the drugs are also prescribed for people with dementia, attention-deficity hyperactivity disorder (ADHD), bipolar disorder and depression where - despite equal risks - there is much less evidence about their effectiveness.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE50E04O20090115?feedType=RSS&feedName=healthNews&pageNumber=2&virtualBrandChannel=0&sp=true

Antipsychotics in dementia raise risk of death

Antipsychotic drugs have increasingly been used to treat the personality changes and aggression often associated with Alzheimer's disease but there have been increasing concerns about their effects on people's health. A three-year study by researchers at King's College London compared those taking antipsychotic drugs with those taking a placebo. After a year slightly more people in the antipsychotic group had died but after a year and a half survival in the placebo group was 59% compared to 30% among those taking antipsychotics. Over the course of the study the participants given the placebo were 42% less likely to die than those taking antipsychotics. Antipsychotic drugs are also linked to a higher risk of stroke and a decline in brain function.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE50805M20090109?feedType=RSS&feedName=healthNews&sp=true

Latest drug guidance

The Medicines and Healthcare products Regulatory Agency has issued its latest bulletin on the safety of drugs. This includes guidance on the use of typical (first-generation) antipsychotics in people with dementia.

You can download a copy of the guidance by clicking on the link in the title of the post.