Antipsychotic Medication Therapy in Older People - Literature review Example

Running Header: therapy for agitation Name of the Student: Name of the Instructor: Name of the course: Code of the course: Submission date: Introduction Agitation involves a state of hyper arousal, irritability and increased tension which can lead to hyperactivity, confusion and over hostility. It can occur due to various disorders in the body which include fever, pain, drug use and anxiety as well as due to hypersensitivity reactions. According to Williams and Wilkins (2010), agitation may be an indication of underlying medical problem and this makes agitated patients to occasionally become noncompliant with therapy. Agitation can be managed by reducing patients’ stimulation and increasing the familiarity and structure of patients’ environments. In addition, therapy can assist in reducing agitated patients disruptive behavior and improve their communication. This paper is going to discuss antipsychotic medication therapy which helps in reducing agitation in behavioral and psychological symptoms of Dementia (BPSD) in older people. Antipsychotic Medication Therapy Antipsychotic medications are the most reliable and effective means of treating agitation in elderly patients with dementia (Hersch and Sharon, 2007). Antipsychotics medications are those drugs which have been developed in order to treat psychosis in adults who are under the age of 65 years suffering with mental health illnesses. They assist in the treatment of intrusive hallucinations and delusions for patients suffering from behavioral and psychological symptoms of dementia (BPSD). Moreover, the drugs assist in reducing hostility, aggression, restlessness and sleeplessness which are common characteristics of agitation. According to Schneider (2007), antipsychotic drugs are officially approved mainly for the treatment of schizophrenia and bipolar disorder, but they can also be used for other purposes like reducing agitation among elderly people with dementia. The aim of antipsychotic therapy is to improve the behavior of agitated patients without affecting other aspects of dementia like quality of life, function and cognition. The drug is administered orally at the lowest effective dose as well as for the shortest time possible. Continued use of the drug for elderly agitated patients with dementia should be reviewed occasionally with consideration been made in regard to the reduction in its use. On the other hand, the starting dose should be as low as possible in order to reduce the side effects that the drug may cause. In determining the starting dosage, the behavior of the agitated patient should be monitored. Additionally, changes in the patients’ cognition should be frequently assessed so as to provide prescriptions in relation to changing the treatment. Dose increments should be done modestly and they should be made on weekly basis depending on the patient’s response. Successful treatment is indicated by a reduction in agitation among the elderly patients. Maintenance treatment can be appropriate when patients demonstrate a clear benefit from antipsychotic treatment without undue side effects (The Royal Australian and New Zealand College of Psychiatrists, 2010). Nevertheless, the drug should only be withdrawn if the patients indicate adverse consequences and when it is proved that the treatments are ineffective. The withdrawal process should be undertaken slowly and it must be complemented with secondary care in order to prevent the patients from returning to their initial agitation. Biernacki (2007) notes that people with dementia are characterized with agitation and this makes antipsychotic medication to be effective in treating them. Elderly patients with dementia are encouraged to use antipsychotic treatment after undertaking their individual risk benefit analysis in order to prevent the risk of suffering from carebro-vascular illnesses. A study conducted by Trifio at el (2005) indicated that the use of antipsychotic medication has increased and this is due to its ability to treat older people suffering from agitation. The study further indicated that patients who were treated with the drug showed significant improvement in relation to reducing their irritation and aggression. The Royal Australian and New Zealand college of Psychiatrists (2010) affirms that antipsychotic medication has become widely prescribed to ignited older patients with BPSD because they have been perceived to carry less risk of causing other diseases as compared to traditional medication. Patients suffering with BPSD are dangerous and disruptive hence antipsychotic medication therapy presents the best option of curing them especially when they are severely agitated or when the patients present a risk of harming themselves. However, studies conducted by Tampi at el (2011) found out that the use of antipsychotic medication therapy for ignited patients with dementia is not particularly effective. This is due to the fact that the drugs have been associated with increasing the risk of death for the users. This has in turn raised concerns regarding its use in managing BPSD in elderly persons. Furthermore, the use of antipsychotic to treat ignited patients with BPSD is mostly unlicensed and this increases the responsibilities of the individual prescribers (Regional Drug and Therapeutics Centre, 2010). Biernacki (2007) emphasizes that antipsychotic drugs should only be used after taking into consideration the likely benefits and side effects that they can cause on agitated patients with dementia. The drug can cause adverse negative effects on elderly patients hence the need to use it with due care. Moreover, antipsychotic drugs should not be used as first line treatment because they can affect the body systems and this can make it difficult to manage agitation in older patients with BPSD. Benefits of using Antipsychotic Medication Therapy Studies conducted by Leduc and Reddy (2012) indicated that antipsychotic medication therapy improves behavioral symptoms of elderly patients with dementia. The study was conducted using 100 elderly people who were suffering from BPSD. According to them, antipsychotic medication helps in reducing tension and irritability which is common to patients who are agitated and suffering with dementia. Antipsychotic drugs play an important role in reducing agitation and dementia in elderly patients. Husebo at el (2011) affirms that patients who are administered with antipsychotic medication indicate a reduction in their agitation because they receive sedation with opioid analgesics. In addition, the drug assists by a large extent in reducing pain that agitated patients may experience as a result of having dementia. Efficient management of pain is important in the treatment of agitation among elderly patients with BPSD (Trifio at el, 2005). According to Tampi at el (2011), antipsychotic drugs are the most effective in reducing aggression in patients with dementia. Clozapine and olazapine that are contained in the drug play a significant role in reducing the severity of aggressive behavior hence this is important in reducing agitation. In addition, Clozapine is superior in reducing the magnitude of physical assaults. This is important in managing agitation and dementia in elderly patients hence it assists in controlling their disruptive behavior. Antipsychotic medication provides a primary and secondary means of managing behavioral difficulties that may characterize patients with dementia. Regional Drug and Therapeutics Centre (2010) notes that the medication is considered as an alternative method due to its ability to provide treatment to patients suffering with dementia where other approaches have failed. A study conducted by Schneider (2007) indicated that antipsychotic medication therapy is effective in reducing agitation and psychosis in patients with dementia. In addition, the study found out that those patients with dementia who did not use antipsychotic drugs were at a higher probability of being admitted in hospitals and more likely to die as compared to those who used the drug. Therefore, antipsychotic medication provides an effective solution to patients who are agitated, aggressive or psychotic and who fail to respond to other measures. It provides a means through which patients with PTSD can overcome their traumatic events and thereby assist them in reducing their agitation. Risks associated with Antipsychotic Medication Therapy Regional Drugs and Therapeutics Centre (2010) notes that there exists a significant evidence which suggests that patients with dementia are at a very high risk of experiencing potentially serious adverse effects by using antipsychotic medication therapy. Antipsychotic drugs have been associated with causing carebrovascular adverse effects (CVAEs) especially stroke. Leduc and Reddy (2012) affirms that CVAEs that result from using antipsychotic drugs range from transient ischemic attacks to strokes as well as non-specific turns. Older people have a higher risk of CVAEs caused by using antipsychotics. A study conducted by Hersch and Sharon (2007) indicated that there was a potential association between antipsychotic medication and cerebrovascular events in older patients with dementia. The study noted that higher incidents of CVAEs occurred to patients who were treated using antipsychotic drugs as compared to those who did not use it. The study further found out that all the patients who experienced cerebrovascular had other risk factors associated with stroke which include hypertension, atrial fibrillation and transient ischemic attacks. Therefore, the use of antipsychotic drugs to treat agitation in elderly patients with BPSD exposes them to risks related to CVAEs. A meta-analysis of randomized control trials in dementia patients conducted by Williams and Wilkins (2010) indicated an increase in risk of mortality which was associated with the use of antipsychotic medication. The study was conducted using 165 patients in care homes who were suffering with agitation and dementia. The study found out that the use of antipsychotic drugs increased the mortality rate of old people by 5-8%. Tampi at el (2011) emphasizes that the use of antipsychotic medication in treating agitation in elderly patients with dementia is associated with increased mortality. They conducted a study and found out that among 17 elderly patients with dementia and agitation, 15 showed a significant increase in mortality after receiving antipsychotic medication. Most of the deaths were attributed to either infections or heart related factors. Furthermore, the study results indicated that more deaths occurred to elderly patients who were using antipsychotic drugs as compared to patients who were using other drugs. The deaths are associated with the adverse events that are caused by the drugs. Therefore, the use of antipsychotic medication therapy is associated with increased risk of death. This has in turn made many health organizations around the world to issue warnings regarding the use of the drug in treating agitation in older patients. Antipsychotic medication has a potential risk of causing Tardive Dyskinesia (TD). A study conducted by Boyd (2009) indicated that a greater proportion of patients with dementia and agitation using antipsychotic drugs developed TD as compared to those who did not use the medication. According to her, antipsychotic medication therapy has a high potential of causing TD to older patients with dementia and agitation. Tampi at el (2011) affirms that older patients have a higher probability of suffering with TD as a result of using antipsychotic drugs. This can in turn make them to experience complications which include risk of choking and loss of ability to swallow. Moreover, antipsychotic medication can cause older patients to gain weight hence this increases the risk of TD. According to Hersch and Sharon (2007), older people with dementia and agitation are at a higher risk of TD due to drug induced weight gain that occurs as a result of using antipsychotic medication. Furthermore, the increased weight exposes the patients to a higher risk for type 2 diabetes. Studies conducted by Leduc and Reddy (2012) found out that older patients suffering with dementia and agitation indicated weight gains after receiving antipsychotic medication therapy for 10 weeks. Older patients with dementia find it difficult to control their weight hence this increases their chances of being diagnosed with TD. Conclusion Older patients with dementia and agitation display a state of hyper arousal, irritation and increased tension. However, antipsychotic medications provide the most reliable and effective means of treating them. Antipsychotic drugs play a significant role in reducing aggressive behavior hence this is important in reducing agitation in older patients with dementia. Nevertheless, antipsychotic medication therapy exposes patients to the risk of experiencing potentially serious adverse effects. Moreover, the drug has been associated with increasing mortality rate among older patients with dementia. References Boyd, M.(2009). Antipsychotics: Impact on Health and Quality of Life. Journal of American Psychiatric Nurses Association. 8(4), 9-17. Hersch, E ., & Falzgraf, S.(2007). Management of Behavioral and Psychological Symptoms of Dementia. Journal of Clinical Inventions in Aging, 2(4), 611-621. Husebo, B., Ballard, C., Sandvic, R., & Aarsland, D.(2011). Efficacy of Treating Pain to Reduce Behavioral Disturbances in Residents of Nursing Homes with Dementia. BMJ, 10(1). 1-10. Leduc, J., & Reddy, M.(2012). Evidence Based Medicine. Hoboken: John Wiley & Sons. Regional Drug and Therapeutics Centre (2010).Antipsychotic use in the Elderly with Dementia. Safer Medication Use, 9(1), 1-3. Schneider, L.(2006). Effectiveness of Antipsychotic Medication in Patients with Dementia. New England Journal of Medicine, 355(15), 1525-1538. Tampi, R., Williamson, D., Muralee, S., & Thomas, J.(2011). Behavioral and Psychological Symptoms of Dementia: Part II Treatment. Neurology, 3(1), 1-9. The Royal Australian and New Zealand College of Psychiatrists.(2010). The Use of Antipsychotics in Residential Aged Care. Risk of Antipsychotics, 1(1), 1-18. Trifiro, G., Brignoli, O., Sessa, E., & Caputi, A.(2005). Antiphychotic Prescribing Pattern among Italian General Practitioners. European Journal of Clinical Pharmacol, 61(1), 47-53. Williams, L., & Wilkins, S.(2010). Rapid Assessment. New York: Wolters Kluwer Health. Read More