Tuesday, 30 April 2013

The Risk of Relapse of Agitation and Psychosis Increases if you Stop Risperidone in People with Alzheimer’s

New England Journal of Medicine 2012; 367:1497-1507 October 18, 2012 DOI: 10.1056/NEJMoa1114058

The New England Journal of Medicine has a paper on the risks of relapse of agitation and psychosis in people with Alzheimer’s who have stopped risperidone. Presumably this is a reaction to the movement not to prescribe antipsychotics to people with dementia because of the increased risk of strokes and short term cognitive problems.

In a small study the authors randomized in a double blind trial 110 people with Alzheimer’s who had responded to risperidone for “agitation” or psychosis to either continuing risperidone for 32 weeks; continuing placebo for 32 weeks; or a half and half group who got risperidone for 16 weeks and then placebo for 16 weeks.

Not surprisingly the rate of relapse in the people who continued was lower than those who continued on risperidone with about a third of people on risperidone relapsing compared to two thirds relapsing on placebo. However none of the groups seem to have received any psychological treatment for “agitation” so I wasn’t sure what clinical conclusions to draw from this paper.

In clinical practice the choice is often between offering drugs or psychological and environmental manipulation to manage these problems. The other thing to note, as the authors point out is that risperidone actually wasn’t that effective in treating the symptoms it was prescribed for with between a third and two thirds of people stopping risperidone for some reason.

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