title: Trends in antipsychotic use in dementia 1999-2007.
abstract: BACKGROUND
  Use of atypical antipsychotics for neuropsychiatric symptoms of dementia increased markedly in the 1990s. Concerns about their use began to emerge in 2002, and in 2005, the US Food and Drug Administration warned that use of atypical antipsychotics in dementia was associated with increased mortality.
  
  
  OBJECTIVE
  To examine changes in atypical and conventional antipsychotic use in outpatients with dementia from 1999 through 2007.
  
  
  METHODS
  Time-series analyses estimated the effect of the various warnings on atypical and conventional antipsychotic usage using national Veterans Affairs data across 3 periods: no warning (1999-2003), early warning (2003-2005), and black box warning (2005-2007).
  
  
  METHODS
  Patients aged 65 years or older with dementia (n = 254 564).
  
  
  METHODS
  Outpatient antipsychotic use (percentage of patients, percentage of quarterly change, and difference between consecutive study periods).
  
  
  RESULTS
  In 1999, 17.7% (95% confidence interval [CI], 17.2-18.1) of patients with dementia were using atypical or conventional antipsychotics. Overall use began to decline during the no-warning period (rate per quarter, -0.12%; 95% CI, -0.16 to -0.07; P < .001). Following the black box warning, the decline continued (rate, -0.26%; 95% CI, -0.34 to -0.18; P < .001), with a significant difference between the early and black box warning periods (P = .006). Use of atypical antipsychotics as a group increased during the no-warning period (rate, 0.23; 95% CI, 0.17-0.30; P < .001), started to decline during the early-warning period (rate, -0.012; 95% CI, -0.14 to 0.11; P = .85), and more sharply declined during the black box warning period (rate, -0.27; 95% CI, -0.36 to -0.18; P < .001). Olanzapine and risperidone showed declining rates and quetiapine showed an increase during the early-warning period, but rates of use for all 3 antipsychotics declined during the black box warning period. In the black box warning period, there was a small but significant increase in anticonvulsant prescriptions (rate, 0.117; 95% CI, 0.08-0.16; P < .001).
  
  
  CONCLUSIONS
  Use of atypical antipsychotics began to decline significantly in 2003, and the Food and Drug Administration advisory was temporally associated with a significant acceleration in the decline.
authors.affiliation: Veterans Affairs Health Services Researchand Development Center for Clinical Management Research, Serious Mental Illness Treatment, Resource, and Evaluation Center, Ann Arbor, Michigan, USA. kales@umich.edu
authors.forename: Helen C
authors.initials: HC
authors.lastname: Kales
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Claire
authors.initials: C
authors.lastname: Chiang
authors.forename: Rosalinda V
authors.initials: RV
authors.lastname: Ignacio
authors.forename: Rosalindo
authors.initials: R
authors.lastname: Ignacio
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.forename: Francesca
authors.initials: F
authors.lastname: Cunningham
authors.forename: Lon S
authors.initials: LS
authors.lastname: Schneider
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016001:Confidence Intervals; D003704:Dementia / Q000188:drug therapy* / Q000401:mortality*; D004348:Drug Labeling / Q000639:trends; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D015996:Survival Rate; D014481:United States; D014486:United States Food and Drug Administration; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000927:Anticonvulsants; D014150:Antipsychotic Agents