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Antipsychotics Still Widely Used in U.S. Nursing Homes
Date:1/11/2010

essor of medicine at the University of Massachusetts Medical School in Worcester.

Briesacher's study concluded that seniors who were admitted to nursing homes that already had high rates of prescribing antipsychotics were more likely to get these drugs as well, indicating that an "organizational culture" may be driving the trend.

But according to Dr. Davangere Devanand, director of geriatric psychiatry at the New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons in New York City, there's little else to control aggression and agitation.

"The only medications that have been shown to work are antipsychotics, but the problem is they have side effects so you get into a situation where it may work in some patients but it may cause some significant side effects in some patients. It's a balance," he said.

Dorsey's study looked mainly at atypical antipsychotic drug use -- meaning second-generation drugs. Clozapine, the first atypical antipsychotic, was introduced in the United States in 1989 and later was followed by risperidone, olanzapine and paliperidone, according to background information with the study.

The researchers looked at the number of times the subject of antipsychotics was brought up during doctors' office visits.

Between the beginning of January 2003 and March 2005, these mentions accelerated at a rate of 34 percent per year, 16 percent among elderly patients with dementia.

In the year after the advisory was issued, mention of atypical drugs dropped 2 percent overall and 19 percent among the dementia population. The declines were evident within one month of the warning.

And by 2008, antipsychotic use among this older population decreased more than 50 percent.

It's not clear if that drop was "enough," or if the drugs are still being overprescribed, said Dorsey.

"Whether or not 19 percent is an appropriate decreas
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