title: A randomized, placebo-controlled trial of the discontinuation of long-term antipsychotics in dementia.
abstract: The objectives of this randomized clinical trial were to investigate the impact of the discontinuation of long-term antipsychotics in residents with dementia in chronic care institutions and to identify clinical predictors of safe discontinuation. Subjects included 34 residents with dementia who were on antipsychotics for more than 6 months and whose behavior was currently stable. Subjects were randomized to either continue receiving their regular dosage of antipsychotics or to receive placebo for 6 months. Early withdrawal from the study was not statistically different between the groups (relative risk [RR] = 1.57, 95% confidence interval [CI] 0.76-3.26), and though not significantly different, subjects in the placebo group were more likely to be withdrawn from the study because of worsening behavior (RR = 1.25, 95% Cl 0.33-4.76). Three subjects in the placebo group were withdrawn from the study due to worsening of extrapyramidal symptoms. The active treatment group had more behavioral problems (e.g., physical aggression towards others, p < .05) compared to the placebo group. The placebo group developed more apathy, but balancing this outcome was a relative improvement in cognitive functioning. Baseline antipsychotic dose was predictive of behavioral worsening upon discontinuation of long-term antipsychotic drugs. The primary limitation of the study was the small sample size. In conclusion, a trial of discontinuation of antipsychotics should be considered in this population.
authors.affiliation: Baycrest Centre for Geriatric Care, Toronto, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: van Reekum
authors.forename: Diana
authors.initials: D
authors.lastname: Clarke
authors.forename: David
authors.initials: D
authors.lastname: Conn
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.forename: Goran
authors.initials: G
authors.lastname: Eryavec
authors.forename: Tammy
authors.initials: T
authors.lastname: Cohen
authors.forename: Laurie
authors.initials: L
authors.lastname: Ostrander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003704:Dementia / Q000523:psychology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology*; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology*; D013995:Time
chemical_list: D014150:Antipsychotic Agents