Antipsychotic Discontinuation in Patients with Dementia: A Systematic Review and Meta-Analysis of Published Randomized Controlled Studies
Background: There is a lack of clarity in the literature on the impact of antipsychotic discontinuation in dementia. Method: We conducted a systematic review and meta-analysis of published randomized controlled studies comparing the effects of antipsychotic discontinuation versus continuation in dem...
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| Veröffentlicht in: | Dementia and geriatric cognitive disorders 2014-01, Vol.37 (3-4), p.125-140 |
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| creator | Pan, Yi-Ju Wu, Chi-Shin Gau, Susan Shur-Fen Chan, Hung-Yu Banerjee, Sube |
| description | Background: There is a lack of clarity in the literature on the impact of antipsychotic discontinuation in dementia. Method: We conducted a systematic review and meta-analysis of published randomized controlled studies comparing the effects of antipsychotic discontinuation versus continuation in dementia. MEDLINE, EMBASE, PsycInfo, Cochrane Library and CINAHL were searched. Severity change of behavioral and psychological symptoms of dementia (BPSD) was the primary outcome. Results: Ten studies were included in the systematic review and 9 studies in the meta-analysis. The results showed that the antipsychotic discontinuation group had no statistically significant difference in BPSD severity change compared to the continuation group (n = 214, standardized mean difference: 0.19, 95% CI: -0.20 to 0.58). Secondary outcome analyses revealed that the discontinuation group included a statistically significantly higher proportion of subjects whose BPSD severity worsened (n = 366, risk ratio: 1.78, 95% CI: 1.31-2.41). Although not statistically significant, the discontinuation group appeared to have higher early study termination rates and a lower mortality during follow-up. Conclusions: This meta-analysis showed that antipsychotic discontinuation resulted in no statistically significant difference in BPSD severity change, early study terminations and mortality. However, a statistically significantly higher proportion of subjects with BPSD worsened in this group compared to the continuation group. Further studies are needed to explore the effects of antipsychotic discontinuation on BPSD. |
| doi_str_mv | 10.1159/000355418 |
| format | Article |
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Method: We conducted a systematic review and meta-analysis of published randomized controlled studies comparing the effects of antipsychotic discontinuation versus continuation in dementia. MEDLINE, EMBASE, PsycInfo, Cochrane Library and CINAHL were searched. Severity change of behavioral and psychological symptoms of dementia (BPSD) was the primary outcome. Results: Ten studies were included in the systematic review and 9 studies in the meta-analysis. The results showed that the antipsychotic discontinuation group had no statistically significant difference in BPSD severity change compared to the continuation group (n = 214, standardized mean difference: 0.19, 95% CI: -0.20 to 0.58). Secondary outcome analyses revealed that the discontinuation group included a statistically significantly higher proportion of subjects whose BPSD severity worsened (n = 366, risk ratio: 1.78, 95% CI: 1.31-2.41). Although not statistically significant, the discontinuation group appeared to have higher early study termination rates and a lower mortality during follow-up. Conclusions: This meta-analysis showed that antipsychotic discontinuation resulted in no statistically significant difference in BPSD severity change, early study terminations and mortality. However, a statistically significantly higher proportion of subjects with BPSD worsened in this group compared to the continuation group. Further studies are needed to explore the effects of antipsychotic discontinuation on BPSD.</description><identifier>ISSN: 1420-8008</identifier><identifier>EISSN: 1421-9824</identifier><identifier>DOI: 10.1159/000355418</identifier><identifier>PMID: 24157687</identifier><identifier>CODEN: DGCDFX</identifier><language>eng</language><publisher>Basel, Switzerland: Karger</publisher><subject>Antipsychotic Agents - administration & dosage ; Antipsychotic Agents - adverse effects ; Behavioral Symptoms ; Biological and medical sciences ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Dementia ; Dementia - drug therapy ; General aspects ; Humans ; Medical sciences ; Neurology ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Randomized Controlled Trials as Topic ; Review Article ; Substance Withdrawal Syndrome - diagnosis ; Systematic review ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Dementia and geriatric cognitive disorders, 2014-01, Vol.37 (3-4), p.125-140</ispartof><rights>2013 S. Karger AG, Basel</rights><rights>2015 INIST-CNRS</rights><rights>Copyright (c) 2014 S. Karger AG, Basel</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-f3ca8acd74ad611466f895bd4b49bc8e251f292312916bd6d14e82e44ad66433</citedby><cites>FETCH-LOGICAL-c425t-f3ca8acd74ad611466f895bd4b49bc8e251f292312916bd6d14e82e44ad66433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,2423,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28451991$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24157687$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pan, Yi-Ju</creatorcontrib><creatorcontrib>Wu, Chi-Shin</creatorcontrib><creatorcontrib>Gau, Susan Shur-Fen</creatorcontrib><creatorcontrib>Chan, Hung-Yu</creatorcontrib><creatorcontrib>Banerjee, Sube</creatorcontrib><title>Antipsychotic Discontinuation in Patients with Dementia: A Systematic Review and Meta-Analysis of Published Randomized Controlled Studies</title><title>Dementia and geriatric cognitive disorders</title><addtitle>Dement Geriatr Cogn Disord</addtitle><description>Background: There is a lack of clarity in the literature on the impact of antipsychotic discontinuation in dementia. Method: We conducted a systematic review and meta-analysis of published randomized controlled studies comparing the effects of antipsychotic discontinuation versus continuation in dementia. MEDLINE, EMBASE, PsycInfo, Cochrane Library and CINAHL were searched. Severity change of behavioral and psychological symptoms of dementia (BPSD) was the primary outcome. Results: Ten studies were included in the systematic review and 9 studies in the meta-analysis. The results showed that the antipsychotic discontinuation group had no statistically significant difference in BPSD severity change compared to the continuation group (n = 214, standardized mean difference: 0.19, 95% CI: -0.20 to 0.58). Secondary outcome analyses revealed that the discontinuation group included a statistically significantly higher proportion of subjects whose BPSD severity worsened (n = 366, risk ratio: 1.78, 95% CI: 1.31-2.41). Although not statistically significant, the discontinuation group appeared to have higher early study termination rates and a lower mortality during follow-up. Conclusions: This meta-analysis showed that antipsychotic discontinuation resulted in no statistically significant difference in BPSD severity change, early study terminations and mortality. However, a statistically significantly higher proportion of subjects with BPSD worsened in this group compared to the continuation group. Further studies are needed to explore the effects of antipsychotic discontinuation on BPSD.</description><subject>Antipsychotic Agents - administration & dosage</subject><subject>Antipsychotic Agents - adverse effects</subject><subject>Behavioral Symptoms</subject><subject>Biological and medical sciences</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Dementia</subject><subject>Dementia - drug therapy</subject><subject>General aspects</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Neurology</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Review Article</subject><subject>Substance Withdrawal Syndrome - diagnosis</subject><subject>Systematic review</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>1420-8008</issn><issn>1421-9824</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqN0U9vFCEUAPCJ0dhaPXg3hqQx0cMojwEGvG1265-kjU3b-4QBxqXODFtgbLbfoN9atruuifHgiQf8eA94RfES8HsAJj9gjCvGKIhHxSFQAqUUhD5-iHEpMBYHxbMYrzOrGZdPiwNCgdVc1IfF_WxMbhXXeumT02jhovZ5ZZxUcn5EbkTnObJjiujWpSVa2CFPnPqIZuhyHZMd1Obchf3p7C1So0FnNqlyNqp-HV1EvkPnU9u7uLQGXeR9P7i7HM5zleD7PoeXaTLOxufFk0710b7YjUfF1aeTq_mX8vTb56_z2WmpKWGp7CqthNKmpspwAMp5JyRrDW2pbLWwhEFHJKmASOCt4QaoFcTSDee0qo6Kt9u0q-BvJhtTM-Q3275Xo_VTbIARKVn-UP4_FAOAqGWmx3_Raz-F_AkbRXGdr_OQ8N1W6eBjDLZrVsENKqwbwM2mk82-k9m-3mWc2sGavfzdugze7ICKWvVdUKN28Y8TlIGUkN2rrfuhwncb9mBf5_if24uTs61oVqarfgFcebqC</recordid><startdate>20140101</startdate><enddate>20140101</enddate><creator>Pan, Yi-Ju</creator><creator>Wu, Chi-Shin</creator><creator>Gau, Susan Shur-Fen</creator><creator>Chan, Hung-Yu</creator><creator>Banerjee, Sube</creator><general>Karger</general><general>S. 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Leukodystrophies. Prion diseases</topic><topic>Dementia</topic><topic>Dementia - drug therapy</topic><topic>General aspects</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Neurology</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Review Article</topic><topic>Substance Withdrawal Syndrome - diagnosis</topic><topic>Systematic review</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pan, Yi-Ju</creatorcontrib><creatorcontrib>Wu, Chi-Shin</creatorcontrib><creatorcontrib>Gau, Susan Shur-Fen</creatorcontrib><creatorcontrib>Chan, Hung-Yu</creatorcontrib><creatorcontrib>Banerjee, Sube</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Science Database</collection><collection>Social Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Dementia and geriatric cognitive disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pan, Yi-Ju</au><au>Wu, Chi-Shin</au><au>Gau, Susan Shur-Fen</au><au>Chan, Hung-Yu</au><au>Banerjee, Sube</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antipsychotic Discontinuation in Patients with Dementia: A Systematic Review and Meta-Analysis of Published Randomized Controlled Studies</atitle><jtitle>Dementia and geriatric cognitive disorders</jtitle><addtitle>Dement Geriatr Cogn Disord</addtitle><date>2014-01-01</date><risdate>2014</risdate><volume>37</volume><issue>3-4</issue><spage>125</spage><epage>140</epage><pages>125-140</pages><issn>1420-8008</issn><eissn>1421-9824</eissn><coden>DGCDFX</coden><abstract>Background: There is a lack of clarity in the literature on the impact of antipsychotic discontinuation in dementia. Method: We conducted a systematic review and meta-analysis of published randomized controlled studies comparing the effects of antipsychotic discontinuation versus continuation in dementia. MEDLINE, EMBASE, PsycInfo, Cochrane Library and CINAHL were searched. Severity change of behavioral and psychological symptoms of dementia (BPSD) was the primary outcome. Results: Ten studies were included in the systematic review and 9 studies in the meta-analysis. The results showed that the antipsychotic discontinuation group had no statistically significant difference in BPSD severity change compared to the continuation group (n = 214, standardized mean difference: 0.19, 95% CI: -0.20 to 0.58). Secondary outcome analyses revealed that the discontinuation group included a statistically significantly higher proportion of subjects whose BPSD severity worsened (n = 366, risk ratio: 1.78, 95% CI: 1.31-2.41). Although not statistically significant, the discontinuation group appeared to have higher early study termination rates and a lower mortality during follow-up. Conclusions: This meta-analysis showed that antipsychotic discontinuation resulted in no statistically significant difference in BPSD severity change, early study terminations and mortality. However, a statistically significantly higher proportion of subjects with BPSD worsened in this group compared to the continuation group. Further studies are needed to explore the effects of antipsychotic discontinuation on BPSD.</abstract><cop>Basel, Switzerland</cop><pub>Karger</pub><pmid>24157687</pmid><doi>10.1159/000355418</doi><tpages>16</tpages></addata></record> |
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| ispartof | Dementia and geriatric cognitive disorders, 2014-01, Vol.37 (3-4), p.125-140 |
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| source | Karger Journals; MEDLINE; Alma/SFX Local Collection |
| subjects | Antipsychotic Agents - administration & dosage Antipsychotic Agents - adverse effects Behavioral Symptoms Biological and medical sciences Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Dementia Dementia - drug therapy General aspects Humans Medical sciences Neurology Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Randomized Controlled Trials as Topic Review Article Substance Withdrawal Syndrome - diagnosis Systematic review Vascular diseases and vascular malformations of the nervous system |
| title | Antipsychotic Discontinuation in Patients with Dementia: A Systematic Review and Meta-Analysis of Published Randomized Controlled Studies |
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