[ { "key": "ZMN6WHUZ", "version": 4306, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/ZMN6WHUZ", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/ZMN6WHUZ", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "Gill et al.", "parsedDate": "2007-06-05", "numChildren": 1 }, "data": { "key": "ZMN6WHUZ", "version": 4306, "itemType": "journalArticle", "title": "Antipsychotic drug use and mortality in older adults with dementia", "creators": [ { "creatorType": "author", "firstName": "Sudeep S", "lastName": "Gill" }, { "creatorType": "author", "firstName": "Susan E", "lastName": "Bronskill" }, { "creatorType": "author", "firstName": "Sharon-Lise T", "lastName": "Normand" }, { "creatorType": "author", "firstName": "Geoffrey M", "lastName": "Anderson" }, { "creatorType": "author", "firstName": "Kathy", "lastName": "Sykora" }, { "creatorType": "author", "firstName": "Kelvin", "lastName": "Lam" }, { "creatorType": "author", "firstName": "Chaim M", "lastName": "Bell" }, { "creatorType": "author", "firstName": "Philip E", "lastName": "Lee" }, { "creatorType": "author", "firstName": "Hadas D", "lastName": "Fischer" }, { "creatorType": "author", "firstName": "Nathan", "lastName": "Herrmann" }, { "creatorType": "author", "firstName": "Jerry H", "lastName": "Gurwitz" }, { "creatorType": "author", "firstName": "Paula A", "lastName": "Rochon" } ], "abstractNote": "BACKGROUND: Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety.\nOBJECTIVE: To examine the association between treatment with antipsychotics (both conventional and atypical) and all-cause mortality.\nDESIGN: Population-based, retrospective cohort study.\nSETTING: Ontario, Canada.\nPATIENTS: Older adults with dementia who were followed between 1 April 1997 and 31 March 2003.\nMEASUREMENTS: The risk for death was determined at 30, 60, 120, and 180 days after the initial dispensing of antipsychotic medication. Two pairwise comparisons were made: atypical versus no antipsychotic use and conventional versus atypical antipsychotic use. Groups were stratified by place of residence (community or long-term care). Propensity score matching was used to adjust for differences in baseline health status.\nRESULTS: A total of 27,259 matched pairs were identified. New use of atypical antipsychotics was associated with a statistically significant increase in the risk for death at 30 days compared with nonuse in both the community-dwelling cohort (adjusted hazard ratio, 1.31 [95% CI, 1.02 to 1.70]; absolute risk difference, 0.2 percentage point) and the long-term care cohort (adjusted hazard ratio, 1.55 [CI, 1.15 to 2.07]; absolute risk difference, 1.2 percentage points). Excess risk seemed to persist to 180 days, but unequal rates of censoring over time may have affected these results. Relative to atypical antipsychotic use, conventional antipsychotic use was associated with a higher risk for death at all time points. Sensitivity analysis revealed that unmeasured confounders that increase the risk for death could diminish or eliminate the observed associations.\nLIMITATIONS: Information on causes of death was not available. Many patients did not continue their initial treatments after 1 month of therapy. Unmeasured confounders could affect associations.\nCONCLUSIONS: Atypical antipsychotic use is associated with an increased risk for death compared with nonuse among older adults with dementia. The risk for death may be greater with conventional antipsychotics than with atypical antipsychotics.", "publicationTitle": "Annals of internal medicine", "publisher": "", "place": "", "date": "Jun 5, 2007", "volume": "146", "issue": "11", "section": "", "partNumber": "", "partTitle": "", "pages": "775-786", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann. Intern. Med.", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1539-3704", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 17548409", "tags": [ { "tag": "Aged", "type": 1 }, { "tag": "Aged, 80 and over", "type": 1 }, { "tag": "Antipsychotic Agents", "type": 1 }, { "tag": "Dementia", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Matched-Pair Analysis", "type": 1 }, { "tag": "Ontario", "type": 1 }, { "tag": "Risk Assessment", "type": 1 }, { "tag": "Sensitivity and Specificity", "type": 1 }, { "tag": "Time Factors", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2013-04-04T10:24:21Z", "dateModified": "2013-04-04T10:24:21Z" } }, { "key": "XBDA46V8", "version": 4306, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/XBDA46V8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/XBDA46V8", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/18711/items/ZMN6WHUZ", "type": "application/json" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } } }, "data": { "key": "XBDA46V8", "version": 4306, "parentItem": "ZMN6WHUZ", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-04-04T10:24:21Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/17548409", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-04-04T10:24:21Z", "dateModified": "2013-04-04T10:24:21Z" } }, { "key": "QK9TK4ZQ", "version": 4306, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/QK9TK4ZQ", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/QK9TK4ZQ", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "Schneider et al.", "parsedDate": "2005-10-19", "numChildren": 1 }, "data": { "key": "QK9TK4ZQ", "version": 4306, "itemType": "journalArticle", "title": "Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials", "creators": [ { "creatorType": "author", "firstName": "Lon S", "lastName": "Schneider" }, { "creatorType": "author", "firstName": "Karen S", "lastName": "Dagerman" }, { "creatorType": "author", "firstName": "Philip", "lastName": "Insel" } ], "abstractNote": "CONTEXT: Atypical antipsychotic medications are widely used to treat delusions, aggression, and agitation in people with Alzheimer disease and other dementia; however, concerns have arisen about the increased risk for cerebrovascular adverse events, rapid cognitive decline, and mortality with their use.\nOBJECTIVE: To assess the evidence for increased mortality from atypical antipsychotic drug treatment for people with dementia.\nDATA SOURCES: MEDLINE (1966 to April 2005), the Cochrane Controlled Trials Register (2005, Issue 1), meetings presentations (1997-2004), and information from the sponsors were searched using the terms for atypical antipsychotic drugs (aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone), dementia, Alzheimer disease, and clinical trial.\nSTUDY SELECTION: Published and unpublished randomized placebo-controlled, parallel-group clinical trials of atypical antipsychotic drugs marketed in the United States to treat patients with Alzheimer disease or dementia were selected by consensus of the authors.\nDATA EXTRACTION: Trials, baseline characteristics, outcomes, all-cause dropouts, and deaths were extracted by one reviewer; treatment exposure was obtained or estimated. Data were checked by a second reviewer.\nDATA SYNTHESIS: Fifteen trials (9 unpublished), generally 10 to 12 weeks in duration, including 16 contrasts of atypical antipsychotic drugs with placebo met criteria (aripiprazole [n = 3], olanzapine [n = 5], quetiapine [n = 3], risperidone [n = 5]). A total of 3353 patients were randomized to study drug and 1757 were randomized to placebo. Outcomes were assessed using standard methods (with random- or fixed-effects models) to calculate odds ratios (ORs) and risk differences based on patients randomized and relative risks based on total exposure to treatment. There were no differences in dropouts. Death occurred more often among patients randomized to drugs (118 [3.5%] vs 40 [2.3%]. The OR by meta-analysis was 1.54; 95% confidence interval [CI], 1.06-2.23; P = .02; and risk difference was 0.01; 95% CI, 0.004-0.02; P = .01). Sensitivity analyses did not show evidence for differential risks for individual drugs, severity, sample selection, or diagnosis.\nCONCLUSIONS: Atypical antipsychotic drugs may be associated with a small increased risk for death compared with placebo. This risk should be considered within the context of medical need for the drugs, efficacy evidence, medical comorbidity, and the efficacy and safety of alternatives. Individual patient analyses modeling survival and causes of death are needed.", "publicationTitle": "JAMA: the journal of the American Medical Association", "publisher": "", "place": "", "date": "Oct 19, 2005", "volume": "294", "issue": "15", "section": "", "partNumber": "", "partTitle": "", "pages": "1934-1943", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "JAMA", "DOI": "10.1001/jama.294.15.1934", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1538-3598", "archive": "", "archiveLocation": "", "shortTitle": "Risk of death with atypical antipsychotic drug treatment for dementia", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 16234500", "tags": [ { "tag": "Antipsychotic Agents", "type": 1 }, { "tag": "Cerebrovascular Disorders", "type": 1 }, { "tag": "Dementia", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Randomized Controlled Trials as Topic", "type": 1 }, { "tag": "Risk", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2013-04-04T10:23:12Z", "dateModified": "2013-04-04T10:23:12Z" } }, { "key": "E53V7423", "version": 4305, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/E53V7423", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/E53V7423", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/18711/items/QK9TK4ZQ", "type": "application/json" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } } }, "data": { "key": "E53V7423", "version": 4305, "parentItem": "QK9TK4ZQ", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-04-04T10:23:12Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/16234500", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-04-04T10:23:12Z", "dateModified": "2013-04-04T10:23:12Z" } }, { "key": "SET23J43", "version": 4306, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/SET23J43", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/SET23J43", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "Wang et al.", "parsedDate": "2005-12-01", "numChildren": 1 }, "data": { "key": "SET23J43", "version": 4306, "itemType": "journalArticle", "title": "Risk of death in elderly users of conventional vs. atypical antipsychotic medications", "creators": [ { "creatorType": "author", "firstName": "Philip S", "lastName": "Wang" }, { "creatorType": "author", "firstName": "Sebastian", "lastName": "Schneeweiss" }, { "creatorType": "author", "firstName": "Jerry", "lastName": "Avorn" }, { "creatorType": "author", "firstName": "Michael A", "lastName": "Fischer" }, { "creatorType": "author", "firstName": "Helen", "lastName": "Mogun" }, { "creatorType": "author", "firstName": "Daniel H", "lastName": "Solomon" }, { "creatorType": "author", "firstName": "M Alan", "lastName": "Brookhart" } ], "abstractNote": "BACKGROUND: Recently, the Food and Drug Administration (FDA) issued an advisory stating that atypical antipsychotic medications increase mortality among elderly patients. However, the advisory did not apply to conventional antipsychotic medications; the risk of death with these older agents is not known.\nMETHODS: We conducted a retrospective cohort study involving 22,890 patients 65 years of age or older who had drug insurance benefits in Pennsylvania and who began receiving a conventional or atypical antipsychotic medication between 1994 and 2003. Analyses of mortality rates and Cox proportional-hazards models were used to compare the risk of death within 180 days, less than 40 days, 40 to 79 days, and 80 to 180 days after the initiation of therapy with an antipsychotic medication. We controlled for potential confounding variables with the use of traditional multivariate Cox models, propensity-score adjustments, and an instrumental-variable analysis.\nRESULTS: Conventional antipsychotic medications were associated with a significantly higher adjusted risk of death than were atypical antipsychotic medications at all intervals studied (< or =180 days: relative risk, 1.37; 95 percent confidence interval, 1.27 to 1.49; <40 days: relative risk, 1.56; 95 percent confidence interval, 1.37 to 1.78; 40 to 79 days: relative risk, 1.37; 95 percent confidence interval, 1.19 to 1.59; and 80 to 180 days: relative risk, 1.27; 95 percent confidence interval, 1.14 to 1.41) and in all subgroups defined according to the presence or absence of dementia or nursing home residency. The greatest increases in risk occurred soon after therapy was initiated and with higher dosages of conventional antipsychotic medications. Increased risks associated with conventional as compared with atypical antipsychotic medications persisted in confirmatory analyses performed with the use of propensity-score adjustment and instrumental-variable estimation.\nCONCLUSIONS: If confirmed, these results suggest that conventional antipsychotic medications are at least as likely as atypical agents to increase the risk of death among elderly persons and that conventional drugs should not be used to replace atypical agents discontinued in response to the FDA warning.", "publicationTitle": "The New England journal of medicine", "publisher": "", "place": "", "date": "Dec 1, 2005", "volume": "353", "issue": "22", "section": "", "partNumber": "", "partTitle": "", "pages": "2335-2341", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "N. Engl. J. Med.", "DOI": "10.1056/NEJMoa052827", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1533-4406", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 16319382", "tags": [ { "tag": "Aged", "type": 1 }, { "tag": "Aged, 80 and over", "type": 1 }, { "tag": "Antipsychotic Agents", "type": 1 }, { "tag": "Cohort Studies", "type": 1 }, { "tag": "Confounding Factors (Epidemiology)", "type": 1 }, { "tag": "Dementia", "type": 1 }, { "tag": "Drug Therapy", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Mood Disorders", "type": 1 }, { "tag": "Proportional Hazards Models", "type": 1 }, { "tag": "Psychotic Disorders", "type": 1 }, { "tag": "Retrospective Studies", "type": 1 }, { "tag": "Risk", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2013-04-04T10:15:38Z", "dateModified": "2013-04-04T10:15:38Z" } }, { "key": "4AEWPJPV", "version": 4304, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/4AEWPJPV", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/4AEWPJPV", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/18711/items/SET23J43", "type": "application/json" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } } }, "data": { "key": "4AEWPJPV", "version": 4304, "parentItem": "SET23J43", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-04-04T10:15:38Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/16319382", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-04-04T10:15:38Z", "dateModified": "2013-04-04T10:15:38Z" } }, { "key": "G3J7PNDC", "version": 4303, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/G3J7PNDC", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/G3J7PNDC", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/18711/items/JJDS6V5S", "type": "application/json" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "G3J7PNDC", "version": 4303, "parentItem": "JJDS6V5S", "itemType": "attachment", "linkMode": "imported_url", "title": "PubMed Central Full Text PDF", "accessDate": "2013-04-04T10:01:20Z", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415308/pdf/ndt-8-347.pdf", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Margari et al. - 2012 - Aggressive behavior, cognitive impairment, and dep.pdf", "md5": "17f1397ccc0dd9b87e57d973c850f799", "mtime": 1365069681245, "tags": [], "relations": {}, "dateAdded": "2013-04-04T10:01:20Z", "dateModified": "2013-04-04T10:01:21Z" } }, { "key": "MCRJAQ4D", "version": 4302, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/MCRJAQ4D", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/MCRJAQ4D", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/18711/items/JJDS6V5S", "type": "application/json" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } } }, "data": { "key": "MCRJAQ4D", "version": 4302, "parentItem": "JJDS6V5S", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Central Link", "accessDate": "2013-04-04T10:01:20Z", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415308/", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-04-04T10:01:20Z", "dateModified": "2013-04-04T10:01:20Z" } }, { "key": "JJDS6V5S", "version": 4302, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/JJDS6V5S", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/JJDS6V5S", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "Margari et al.", "parsedDate": "2012", "numChildren": 2 }, "data": { "key": "JJDS6V5S", "version": 4302, "itemType": "journalArticle", "title": "Aggressive behavior, cognitive impairment, and depressive symptoms in elderly subjects", "creators": [ { "creatorType": "author", "firstName": "Francesco", "lastName": "Margari" }, { "creatorType": "author", "firstName": "Michele", "lastName": "Sicolo" }, { "creatorType": "author", "firstName": "Lucia", "lastName": "Spinelli" }, { "creatorType": "author", "firstName": "Franco", "lastName": "Mastroianni" }, { "creatorType": "author", "firstName": "Adriana", "lastName": "Pastore" }, { "creatorType": "author", "firstName": "Francesco", "lastName": "Craig" }, { "creatorType": "author", "firstName": "Maria Giuseppina", "lastName": "Petruzzelli" } ], "abstractNote": "Patients with dementia often have neuropsychiatric symptoms. The objective of this study was to evaluate the relationship between neuropsychiatric symptoms and progressive cognitive decline by assessing cognitive impairment, depressive symptoms, and aggressive behavior in a sample of elderly subjects. The study sample consisted of 201 subjects admitted to nursing homes. For the purpose of the present study each subject was evaluated using the Mini-Mental State Examination, the Geriatric Depression Scale, and the Modified Overt Aggression Scale. The results show that aggressive behavior and depressive symptoms are associated with progressive cognitive decline in elderly subjects. Early assessment of these conditions can promote rational therapeutic strategies that may improve the quality of life and delay institutionalization for elderly patients.", "publicationTitle": "Neuropsychiatric Disease and Treatment", "publisher": "", "place": "", "date": "2012", "volume": "8", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "347-353", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Neuropsychiatr Dis Treat", "DOI": "10.2147/NDT.S33745", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415308/", "accessDate": "2013-04-04T10:01:20Z", "PMID": "", "PMCID": "", "ISSN": "1176-6328", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "PMID: 22888255\nPMCID: PMC3415308", "tags": [], "collections": [], "relations": {}, "dateAdded": "2013-04-04T10:01:20Z", "dateModified": "2013-04-04T10:01:20Z" } }, { "key": "GQQIFDIS", "version": 4306, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/GQQIFDIS", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/GQQIFDIS", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "Brodaty et al.", "parsedDate": "2001-05", "numChildren": 1 }, "data": { "key": "GQQIFDIS", "version": 4306, "itemType": "journalArticle", "title": "Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors", "creators": [ { "creatorType": "author", "firstName": "H", "lastName": "Brodaty" }, { "creatorType": "author", "firstName": "B", "lastName": "Draper" }, { "creatorType": "author", "firstName": "D", "lastName": "Saab" }, { "creatorType": "author", "firstName": "L F", "lastName": "Low" }, { "creatorType": "author", "firstName": "V", "lastName": "Richards" }, { "creatorType": "author", "firstName": "H", "lastName": "Paton" }, { "creatorType": "author", "firstName": "D", "lastName": "Lie" } ], "abstractNote": "BACKGROUND: There is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes.\nAIMS: This study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE-AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter-relationships between different types of BPSD, as measured by subscales of the BEHAVE-AD.\nRESULTS: Over 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated.\nCONCLUSIONS: BPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psychosis and/or depression. The findings suggest the need for psychogeriatric services to nursing homes and smaller facilities.", "publicationTitle": "International journal of geriatric psychiatry", "publisher": "", "place": "", "date": "May 2001", "volume": "16", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "504-512", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Int J Geriatr Psychiatry", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0885-6230", "archive": "", "archiveLocation": "", "shortTitle": "Psychosis, depression and behavioural disturbances in Sydney nursing home residents", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 11376467", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Aged", "type": 1 }, { "tag": "Aged, 80 and over", "type": 1 }, { "tag": "Aggression", "type": 1 }, { "tag": "Dementia", "type": 1 }, { "tag": "Depression", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Homes for the Aged", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Mental Disorders", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "New South Wales", "type": 1 }, { "tag": "Nursing Homes", "type": 1 }, { "tag": "Observer Variation", "type": 1 }, { "tag": "Prevalence", "type": 1 }, { "tag": "Psychiatric Status Rating Scales", "type": 1 }, { "tag": "Psychotic Disorders", "type": 1 }, { "tag": "Risk Factors", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2013-04-04T09:57:16Z", "dateModified": "2013-04-04T09:57:16Z" } }, { "key": "VPQ8VCVR", "version": 4301, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/VPQ8VCVR", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/VPQ8VCVR", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/18711/items/GQQIFDIS", "type": "application/json" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } } }, "data": { "key": "VPQ8VCVR", "version": 4301, "parentItem": "GQQIFDIS", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-04-04T09:57:16Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/11376467", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-04-04T09:57:16Z", "dateModified": "2013-04-04T09:57:16Z" } }, { "key": "XXXGAHX3", "version": 4306, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/XXXGAHX3", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/XXXGAHX3", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "Rayner et al.", "parsedDate": "2006-02-15", "numChildren": 1 }, "data": { "key": "XXXGAHX3", "version": 4306, "itemType": "journalArticle", "title": "Behavior disorders of dementia: recognition and treatment", "creators": [ { "creatorType": "author", "firstName": "Abi V", "lastName": "Rayner" }, { "creatorType": "author", "firstName": "James G", "lastName": "O'Brien" }, { "creatorType": "author", "firstName": "Ben", "lastName": "Schoenbachler" }, { "creatorType": "author", "firstName": "Ben", "lastName": "Shoenbachler" } ], "abstractNote": "Psychosis may pose a greater challenge than cognitive decline for patients with dementia and their caregivers. The nature and frequency of psychotic symptoms varies over the course of illness, but in most patients, these symptoms occur more often in the later stages of disease. Management of psychosis requires a comprehensive nonpharmacologic and pharmacologic approach, including an accurate assessment of symptoms, awareness of the environment in which they occur, and identification of precipitants and how they affect patients and their caregivers. Nonpharmacologic interventions include counseling the caregiver about the nonintentional nature of the psychotic features and offering coping strategies. Approaches for the patient involve behavior modification; appropriate use of sensory intervention; environmental safety; and maintenance of routines such as providing meals, exercise, and sleep on a consistent basis. Pharmacologic treatments should be governed by a \"start low, go slow\" philosophy; a monosequential approach is recommended, in which a single agent is titrated until the targeted behavior is reduced, side effects become intolerable, or the maximal dosage is achieved. Atypical antipsychotics have the greatest effectiveness and are best tolerated. Second-line medications include typical antipsychotics for short-term therapy; and, less often, anticonvulsants, acetylcholinesterase inhibitors, antidepressants, and anxiolytics. Goals of treatment should include symptom reduction and preservation of quality of life.", "publicationTitle": "American family physician", "publisher": "", "place": "", "date": "Feb 15, 2006", "volume": "73", "issue": "4", "section": "", "partNumber": "", "partTitle": "", "pages": "647-652", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Am Fam Physician", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0002-838X", "archive": "", "archiveLocation": "", "shortTitle": "Behavior disorders of dementia", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 16506707", "tags": [ { "tag": "Anti-Anxiety Agents", "type": 1 }, { "tag": "Anticonvulsants", "type": 1 }, { "tag": "Antipsychotic Agents", "type": 1 }, { "tag": "Behavior Therapy", "type": 1 }, { "tag": "Dementia", "type": 1 }, { "tag": "Humans", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2013-04-04T09:48:05Z", "dateModified": "2013-04-04T09:48:05Z" } }, { "key": "QDMZ78Q8", "version": 4300, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/QDMZ78Q8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/QDMZ78Q8", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/18711/items/XXXGAHX3", "type": "application/json" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } } }, "data": { "key": "QDMZ78Q8", "version": 4300, "parentItem": "XXXGAHX3", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-04-04T09:48:05Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/16506707", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-04-04T09:48:05Z", "dateModified": "2013-04-04T09:48:05Z" } }, { "key": "NG2M8WDD", "version": 4299, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/NG2M8WDD", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/NG2M8WDD", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "\"American Health Care Association,\"", "parsedDate": "2008-06", "numChildren": 0 }, "data": { "key": "NG2M8WDD", "version": 4299, "itemType": "report", "title": "Medical Condition–Mental Status CMS OSCAR Data Current Surveys", "creators": [ { "creatorType": "author", "name": "\"American Health Care Association,\"" } ], "abstractNote": "", "reportNumber": "", "reportType": "", "institution": "", "place": "", "date": "June 2008", "seriesTitle": "", "seriesNumber": "", "pages": "", "DOI": "", "ISBN": "", "citationKey": "", "url": "", "accessDate": "", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2013-04-04T09:29:27Z", "dateModified": "2013-04-04T09:30:06Z" } }, { "key": "BVS749CC", "version": 4306, "library": { "type": "group", "id": 18711, "name": "PITT-DBMI-ComparativeEffectivenessResearch", "links": { "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/18711/items/BVS749CC", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/pitt-dbmi-comparativeeffectivenessresearch/items/BVS749CC", "type": "text/html" } }, "meta": { "createdByUser": { "id": 8771, "username": "boycer", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/boycer", "type": "text/html" } } }, "creatorSummary": "Kamble et al.", "parsedDate": "2008-10", "numChildren": 1 }, "data": { "key": "BVS749CC", "version": 4306, "itemType": "journalArticle", "title": "Antipsychotic drug use among elderly nursing home residents in the United States", "creators": [ { "creatorType": "author", "firstName": "Pravin", "lastName": "Kamble" }, { "creatorType": "author", "firstName": "Hua", "lastName": "Chen" }, { "creatorType": "author", "firstName": "Jeff", "lastName": "Sherer" }, { "creatorType": "author", "firstName": "Rajender R", "lastName": "Aparasu" } ], "abstractNote": "BACKGROUND: Antipsychotic utilization in elderly nursing home residents has increased substantially in recent years, primarily due to the use of atypical antipsychotic agents. However, few studies have examined antipsychotic utilization patterns in nursing home residents in the United States since the introduction of atypical agents in the 1990s.\nOBJECTIVE: The goal of this study was to examine the prevalence of and the factors associated with antipsychotic drug use among elderly nursing home residents in the United States. Methods: This study involved a cross-sectional analysis of prescription and resident data files from the 2004 National Nursing Home Survey (NNNHS). The analysis focused on the use of 11 typical and 6 atypical antipsychotic agents among a nationally representative sample of elderly patients (aged > or =65 years). Descriptive weighted analysis was performed to examine antipsychotic prevalence patterns. Multiple logistic regression analysis within the conceptual framework of the Andersen behavioral model was used to examine the factors associated with antipsychotic drug use among the elderly nursing home residents.\nRESULTS: According to the 2004 NNHS, 0.32 million elderly nursing home residents received antipsychotic medications, for an overall prevalence of 24.82%. Most received atypical agents (23.45%), while 1.90% received typical agents. Frequently reported diagnoses among the elderly using an antipsychotic agent were dementia (70%), depression (41%), and anxiety (18%). Among the predisposing characteristics, female gender and age (> or =85 years) were negatively associated with antipsychotic drug use. Need factors such as increasing dependence in decision-making ability regarding tasks of daily life, depressed mood indicators, behavioral symptoms, history of falls, and bowel incontinence were positively associated with antipsychotic drug use. In addition to the use of antipsychotic agents in schizophrenia and bipolar mania, this study found high use in conditions such as dementia, anxiety, depression, and parkinsonism in the elderly.\nCONCLUSIONS: Nearly 1 in 4 elderly nursing home residents in the United States received antipsychotic agents. Predisposing and need factors played a vital role in determining the use of antipsychotic agents in these elderly patients. 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