No surprise at all. As dementia patients are already at higher risk for stroke due to metabolic disturbances that are already there, both in vascular and Alzheimer's disease, not mentioning age alone...The real question is whether this is the beginning of the end of the extensive use of atypicals in schizophrenia, and, particularly, in affective disorders. Atypicals lack extrapyramidal phenotype seen for classical neuroleptics, but what if they, instead, shorten patients' lives? Large observational studies are urgently needed to establish atypicals' "real life" safety profile in every indication. "Yellow card" is already here!

View all comments by Tomasz Sobow

My father, suffering from severe dementia, was on the drug zyprexa. He was suffering from hallucinations. He thought there were people in the house who were not there. He thought my mother was someone else. He had a massive stroke 2 weeks ago and died! The stroke was a blockage, not a hemorrhage. This article is very disturbing. We had him on 2.5,5,10 and 15 and then he became very debilitated, so it was reduced slowly down to 10 and 5 and 2.5. He was completely off the drug for 1 week when he had the stroke.

View all comments by Mary Cieri

My Mother entered a nursing home walking, talking, eating and going to the bathroom by herself. She had Alzheimer's but ate breakfast out daily. She entered the home when Dad was hospitalized with a heart attack. She was prescribed zyprexa upon admission and given the right, "to refuse to eat or drink". In approx 5 weeks, she was confined to a wheel chair unable to speak or drink or eat. Obviously, she starved. She was hospitalized for rehydration but was never the same. "The Breakfast Club" group of friends have been very supportive and adamant about her abuse. Her case is complicated because it involves a guardian who was not close to her and, of course, money.

View all comments by Paul LaBounty

My mother entered a nursing home on February 24th after having been discharged fom a hospital, where she had been treated with IV fluids for dehydration and dangerously high saline levels. At her admission to the nursing home she could walk, sometimes in need of assistance. She could speak in sentences, she could feed herself with supervision, and she could read simple signs. In addition, she could indicate her need for toileting.

The first night she was at the nursing home she alarmed the staff by being out of bed because she was looking for the toilet. She had been getting 50mg.of Seroquel at home, which enabled her to sleep at least 8 hours. She received no other neuroleptic medication during the day. The nursing home increased the dosage to 100mgof Seroquel. The report was that she was combative and needed to be controlled. By combative they meant that she was uncooperative in toileting and unspecified tasks.

In about three weeks the family noticed a decline in her ability to talk,walk, and stay awake. She had decreased ability to hold eating utensils and constantly...  Read more

My mother entered a nursing home on February 24th after having been discharged fom a hospital, where she had been treated with IV fluids for dehydration and dangerously high saline levels. At her admission to the nursing home she could walk, sometimes in need of assistance. She could speak in sentences, she could feed herself with supervision, and she could read simple signs. In addition, she could indicate her need for toileting.

The first night she was at the nursing home she alarmed the staff by being out of bed because she was looking for the toilet. She had been getting 50mg.of Seroquel at home, which enabled her to sleep at least 8 hours. She received no other neuroleptic medication during the day. The nursing home increased the dosage to 100mgof Seroquel. The report was that she was combative and needed to be controlled. By combative they meant that she was uncooperative in toileting and unspecified tasks.

In about three weeks the family noticed a decline in her ability to talk,walk, and stay awake. She had decreased ability to hold eating utensils and constantly had food stains all over her clothing. She soon needed a wheelchair. In addition her feet and hands were tremoring. She was becoming increasingly stiff.

These symptoms of neuroleptic malignancy were brought to the staff"s attention several times. It was well over one month before the staff would remove the Seroquel even though material from Pub Med was brought to their attention. When the Seroquel was abruptly withdrawn and the megestrol was withdrawn, my mother again became dehydrated and was placed on IV fluids for several weeks. Now she seems alert. She can on occasion verbalize a thought. She is primarily whelchair-bound.

She needs assistance with feeding, and it has taken much effort to get this to happen. She needs support to sit upright in the wheelchair and has only recetly received the bolster and chair wedges she required. Even other patients would notice and comment on her needs before staff took requisite actions. The presence of her health proxy and holder of her power of attorney and my observations and comments meant nothing to the staff. They seemed to believe my mother was in the end stages of Alzheimer's Disease and that there was little they needed to do. My comments wre seen as symptoms of my inability to 'let go'. This experience has made me aware that there is much field work that needs to be done in distinguishing between symptoms of the disease process,medication effects, and caretaker training, and the effects that training has on perceptions. Gladys Brown,Ph.D.

View all comments by Gladys Brown

Alzheimer patients can be extremely difficult to treat. They can be very dangerous to the caregivers, not to mention the well-documented depression they cause in caregivers.

I know that some clinicians do not think that antipsychotic medications are very effective, but I certainly think they are. I further think that the violent and psychotic patients have more brain damage. Also, violent and psychotic behaviors are very maladaptive and may suggest greater degrees of neuropathology. The pathology, or the maladaptation, likely leads to a higher risk of mortality. Thus, association of medicine use with mortality does not prove causation.

Until I see a study that carefully looks at the neuropathology associated with this increase in mortality of patients receiving antipsychotic medication, I will presume that the patients who are given these drugs actually have a higher risk of mortality and the drugs may actually decrease this risk. In any case, given the severe difficulty with managing patients that leads to the use of such medications, isn't there the issue of allowing...  Read more

Alzheimer patients can be extremely difficult to treat. They can be very dangerous to the caregivers, not to mention the well-documented depression they cause in caregivers.

I know that some clinicians do not think that antipsychotic medications are very effective, but I certainly think they are. I further think that the violent and psychotic patients have more brain damage. Also, violent and psychotic behaviors are very maladaptive and may suggest greater degrees of neuropathology. The pathology, or the maladaptation, likely leads to a higher risk of mortality. Thus, association of medicine use with mortality does not prove causation.

Until I see a study that carefully looks at the neuropathology associated with this increase in mortality of patients receiving antipsychotic medication, I will presume that the patients who are given these drugs actually have a higher risk of mortality and the drugs may actually decrease this risk. In any case, given the severe difficulty with managing patients that leads to the use of such medications, isn't there the issue of allowing patients to die with dignity? These drugs, just like morphine for cancer patients, will provide some measure of better end-of-life care.

Actually, I don't believe that real-life placebo-controlled trials of antipsychotic medications can be conducted, having been involved in many such trials. The most agitated patients need to be managed acutely and cannot participate in such trials. Those who get into such trials probably aren't affected severely enough to warrant the treatment. Looking at placebo discontinuation probably doesn't solve this problem, because dementia patients need to be closely followed over time and have their antipsychotic medications decreased whenever possible, anyway. This issue is noted as a future need, but it has always been just part of appropriate patient care. Antipsychotics are not maintenance medications in this condition; they are for acute management. The need for monitoring and constant medication adjustment could be the best argument for why these drugs really should only be prescribed by those familiar with treating such patients.

There has been some evidence that the use of antipsychotic medications has increased in spite of the black box warning. When a patient is severely agitated, I still think that antipsychotics are the best medication to use.

It should be noted that there is now more experience with trazodone, SSRIs, melatonin, and low doses of the atypical antipsychotic medications, so these patients are a little easier to manage. Further, long-term use of cholinesterase inhibitors and memantine probably decreases the overall behavior problems, though much better research is needed on all of these issues.

View all comments by John (Wes) Ashford