title: Managing risk when considering the use of atypical antipsychotics for elderly patients with dementia-related psychosis.
abstract: In 2005, responding to several studies, the FDA issued a black box warning on atypical (second generation) antipsychotic medications, noting that the drugs may increase the risk of cerebrovascular adverse events in elderly patients with dementia-related behavior disturbances. The black box warning has raised concern for clinicians, among whom atypical antipsychotics have gained favor for having a more tolerable side-effect profile than many other pharmacological treatment options. Complicating this concern are studies suggesting that other medications may have similar risks and a dearth of unbiased head-to-head studies comparing different treatment options. To effectively manage risk when treating elderly patients with dementia-related psychosis, physicians, patients, and caregivers must consider both acute risks (such as danger of bodily harm to the patient and others) and long-term risks (such as placement in a restrictive nursing home). If an atypical antipsychotic is chosen, additional risk management may be warranted. This paper presents a brief overview of relevant concerns and suggests some techniques to help minimize and manage risk, such as increased monitoring, informed consent, and thorough documentation. A sample clinical risk management form and a sample letter to the primary care physician are provided to help guide clinicians in improving their risk management practices when working with elderly patients suffering from dementia-related psychosis and related behavioral difficulties.
authors.affiliation: Brown Medical School and Butler Hospital, Providence, RI 02906, USA. Patricia_Recupero@Brown.edu
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Recupero
authors.forename: Samara E
authors.initials: SE
authors.lastname: Rainey
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004282:Documentation; D016903:Drug Monitoring; D006801:Humans; D007258:Informed Consent; D011356:Product Labeling; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy*; D012308:Risk Management
chemical_list: D014150:Antipsychotic Agents