Effects of antipsychotic withdrawal in elderly nursing home residents.
OBJECTIVE
To study the effects of antipsychotic withdrawal in elderly nursing home residents.


METHODS
Longitudinal prospective study.


METHODS
12 community nursing homes that participated in a randomized controlled trial of an educational program designed to reduce antipsychotic use.


METHODS
271 residents receiving antipsychotics at baseline and remaining in the home for approximately 6 months thereafter. These were placed into two groups: those with continued use of antipsychotics at follow-up (n = 207) and those with drug discontinued (n = 64).


METHODS
Change between baseline and follow-up for several standard measurements. These included behavior problems, as reported by both regular care providers (Nursing Home Behavior Problem Scale) or a blinded study rater (items from the Brief Psychiatric Rating Scale), observer-rated psychiatric symptoms (subset of the Brief Psychiatric Rating Scale), and other standard tests of function (Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale, and Abnormal Involuntary Movements Scale).


RESULTS
The frequency of behavior problems did not increase in residents with antipsychotics discontinued. For these residents, observer-rated psychiatric symptoms decreased by 21% (P = 0.003), which resulted from a 27% decrease in adverse affective symptoms (P = 0.0002). Residents with drug discontinued had no deterioration in any of the measures of function.


CONCLUSIONS
In this sample, nursing home residents whose antipsychotics were discontinued had significantly improved affect and no discernable adverse effects.
Thapa
P B
PB
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Meador
K G
KG
Gideon
P
P
Fought
R L
RL
Ray
W A
WA
D000203:Activities of Daily Living; D000339:Affect / Q000187:drug effects; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001519:Behavior / Q000187:drug effects; D003071:Cognition / Q000187:drug effects; D003704:Dementia / Q000188:drug therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes; D011446:Prospective Studies
D014150:Antipsychotic Agents