title: Dosage and duration of antipsychotic treatment in demented outpatients with agitation or psychosis.
abstract: OBJECTIVE
  The USA Food and Drug Administration (FDA) issued warnings regarding the use of antipsychotics in patients with dementia in 2003 and 2005. We aimed to study the dose and duration of antipsychotic treatment in dementia, and to examine whether physicians' prescription behaviors changed after the FDA warnings.
  
  
  METHODS
  Medical charts of outpatients who had Alzheimer's disease, vascular dementia, or mixed dementia were reviewed. Patients must have achieved a clinically stable state for at least 4 weeks after receiving antipsychotic treatment for agitation or psychosis. Demographics, clinical correlates, and duration of antipsychotic treatment were compared among different antipsychotic groups. Because the quetiapine group had the largest sample size, the optimal dose and duration of quetiapine treatment were compared among three time periods (before 2003, 2003-2005, after 2005).
  
  
  RESULTS
  Stable state was achieved in 215 patients (80 had Alzheimer's disease, 117 vascular dementia, and 18 mixed dementia). Most patients (177) took quetiapine, 25 took risperidone, and 13 took sulpiride. The whole sample had a long total duration of antipsychotic treatment (median 525 days, mean 707 days). The median dose and total duration of antipsychotic treatment were 1.0mg/day and 238 days for risperidone, 100mg/day and 390 days for sulpiride, and 25mg/day and 611 days for quetiapine, respectively. The optimal dose and total duration of quetiapine treatment decreased significantly after FDA warning in 2005, although the duration remained long.
  
  
  CONCLUSIONS
  The optimal doses of antipsychotics were not higher than those of western reports, but the total duration of antipsychotic treatment was quite long. Although our study suggests the prescription dosage and duration of antipsychotic treatment decreased significantly after FDA warning in 2005, the duration of treatment was still long. Given the serious safety concerns, more effort should be made to avoid unnecessary and prolonged prescription.
authors: Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Taiwan, ROC.
authors: Yi-Ting
authors: YT
authors: Lin
authors: Department of Psychiatry, National Taiwan University Hospital, Taiwan, ROC; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan, ROC; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan, ROC. Electronic address: tjhwang@ntu.edu.tw.
authors: Tzung-Jeng
authors: TJ
authors: Hwang
authors: Department of Psychiatry, Cathay General Hospital, Taiwan, ROC.
authors: Jia-Chi
authors: JC
authors: Shan
authors: Department of Psychiatry, National Taiwan University Hospital, Taiwan, ROC; Department of Psychiatry, Far Eastern Memorial Hospital, Taiwan, ROC.
authors: Huey-Ling
authors: HL
authors: Chiang
authors: Department of Psychiatry, Kinmen Hospital, Taiwan, ROC.
authors: Yi-Han
authors: YH
authors: Sheu
authors: Department of Psychiatry, National Taiwan University Hospital, Taiwan, ROC; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan, ROC.
authors: Hai-Gwo
authors: HG
authors: Hwu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011595:Psychomotor Agitation / Q000188:drug therapy*; D000069348:Quetiapine Fumarate / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D018967:Risperidone / Q000008:administration & dosage* / Q000009:adverse effects; D012720:Severity of Illness Index; D013469:Sulpiride / Q000008:administration & dosage* / Q000009:adverse effects; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate; D013469:Sulpiride; D018967:Risperidone
keywords: agitation; antipsychotic agents; dementia; quetiapine; risperidone