Rapid Response

Atypical Antipsychotics, Elderly Patients, and Mortality Risk

Authors: Leslie Citrome, MD, MPH

Abstract

Clinicians faced with the management of disturbed behavior in patients with dementia have a limited array of options. The risk of doing nothing will place the agitated patient at risk for harm to self or others, not to mention the discomfort of this often-dysphoric state. Second-generation, or atypical, antipsychotics such as olanzapine and risperidone can successfully reduce aggression and/or psychosis in patients with dementia1; however, these agents are also associated with serious adverse events, and their routine use in this population is being discouraged. The United States Food and Drug Administration issued a Public Health Advisory in 2005 regarding deaths with antipsychotics in elderly patients with behavioral disturbances,2 and, consequently, the manufacturers of all of the second-generation antipsychotics were required to include a boxed warning regarding this risk. None of these products are actually approved for the treatment of behavioral disorders in patients with dementia, yet these agents are still used in this vulnerable population. How can we quantify this mortality risk in a clinically meaningful way? What can we tell our patients and their families about this risk?

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