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Background: Antipsychotics are frequently used to treat psychosis, aggression and agitation in patients with Alzheimer's disease (AD), but safety warnings abound. Escitalopram was investigated since citalopram has demonstrated some effectiveness in AD. We compared escitalopram and risperidone for psychotic symptoms and agitation associated with AD., Methods: Inpatients with AD, who had been hospitalized because of behavioral symptoms, were recruited to a six-week randomized, double-blind, controlled trial. Participants (n = 40) were randomized to once daily risperidone 1 mg or escitalopram 10 mg., Results: The NPI total score improved in both groups. Onset was earlier in the risperidone-treated group, but improvement did not significantly differ between groups by study end. Completion rates differed for escitalopram (75%) and risperidone (55%), mainly due to adverse events. There were no adverse events in the escitalopram group, while in the risperidone group two patients suffered severe extrapyramidal symptoms and four patients suffered acute physical illness necessitating transfer to general hospital., Conclusion: Escitalopram and risperidone did not differ in efficacy in reducing psychotic symptoms and agitation in patients with AD. Completion rates were higher for escitalopram-treated patients. Replication in larger trials with ambulatory patients is needed.

Depression in elderly patients is often characterized by poor responses to standard antidepressants. Several reports have suggested that quetiapine also may have antidepressant properties. The present study aimed to evaluate the efficacy of quetiapine augmentation in depressed elderly patients previously unresponsive to a full course of treatment. Medical charts of elderly depressed inpatients treated at a tertiary care psychiatric center during a 3-year period were reviewed. Clinical and demographic data were extracted from computerized records and analyzed. The primary outcome measure was the change on the clinical global impressions scale for improvement (CGI-I). Twenty depressed elderly inpatients received quetiapine augmentation during the study period. Prior to augmentation all had been treated with antidepressants. Baseline mean severity of depression was 6.40; severity after augmentation was significantly reduced to 3.25; the change in CGI-I was 2.10 (p<0.03). Mean quetiapine dose was 70 mg; mean duration of augmentation was 3.9 weeks. Five patients complained of somnolence. One patient discontinued psycho-tropics and switched to electroconvulsive therapy (ECT) due to life-threatening suicidal tendencies. We tentatively conclude that quetiapine augmentation for elderly depressed patients unresponsive to standard antidepressant treatment may be a safe and efficacious option. Further prospective studies need be carried out to support our observation., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Setting: Treating elderly patients with Alzheimer's disease (AD) and behavioral and psychological symptoms of dementia (BPSD) is challenging due to the increased risk of iatrogenic movement disorders with old neuroleptics and the seemingly increasing risk of cardiovascular events with newer atypical agents. Quetiapine is an atypical antipsychotic agent that warrants further investigation., Objectives: To assess tolerability, safety, and clinical benefit of quetiapine in AD patients with BPSD., Participants and Design: AD patients with BPSD participated in a 6-week randomized, double-blind, placebo-controlled trial. Quetiapine was increased on the basis of clinical response and tolerability. Primary efficacy assessments included the Neuropsychiatric Inventory (NPI) and Clinical Global Impression of Change (CGI-C). Secondary efficacy measures included the Mini-Mental State Examination (MMSE), the Simpson-Angus Scale (SAS) and the Abnormal Involuntary Movement Scale (AIMS)., Results: Forty patients (26 women), mean age 82.2 (SD 6.4) years were enrolled, 27 completed treatment. Median dose of quetiapine was 200 mg/day. Significant NPI total scores reductions (79% for placebo and 68.5% for quetiapine) were observed. The CGI-C score decreased significantly in the quetiapine group (p = 0.009 at 6 weeks) and did not change significantly in the placebo group (p = 0.48). The MMSE, AIMS, SAS scores and adverse events did not differ significantly between the two arms., Conclusions: Quetiapine did not significantly improve psychosis scores. It did not cause cognitive and motor deterioration. These results might possibly be due to small sample size.

Ten elderly chronic schizophrenia patients who were not responding to an atypical antipsychotic were switched to quetiapine. The Brief Psychiatric Rating Scale (BPRS) demonstrated statistically significant improvement after 6 months of quetiapine treatment. Four patients discontinued treatment due to clinical exacerbation or sedation. There was no increase in abnormal movements or body weight.

Objective: To evaluate the rate of adverse medical outcomes for elderly exposed to antipsychotic treatment., Methods: This was a retrospective evaluation of psychiatric inpatients records. Age, gender, diagnosis, treatment with antipsychotics, and duration of treatment were analyzed. An acute cardiac or cerebrovascular event necessitating transfer to a general hospital or resulting in death was the outcome measure., Results: During 15 years (1990 to 2005), 3,111 elderly were hospitalized. Their mean age was 73.5 +/- 6.1 years, 1,220 were male (39%), and 1,891 were female (61%). Most patients (2,583 [83%]) were exposed to antipsychotics, of which 1,402 (54%) were exposed to second-generation antipsychotics (SGAs). Antipsychotic-treated patients did not have a higher rate of adverse medical outcomes compared with patients who had not received antipsychotics. No significant differences were noted between patients exposed to typical antipsychotics or SGAs., Conclusion: Treatment of elderly psychiatric inpatients with antipsychotics did not increase their risk of adverse medical outcomes. Thus, regulating the use of conventional antipsychotics or SGAs for all elderly patients in all indications may be premature.

Objectives: To study the effect of olanzapine (OL) in Huntington's disease (HD) patients., Design and Methods: Eleven HD patients (five men), aged 47.6 +/- 11.4 years and with disease duration of 11.2 +/- 3.3 years received OL. Assessment was carried out using the Clinical Global Impression of Change Scale (CGIC) and the Unified Huntington's Disease Rating Scale behavioral (UHDRS - b) and motor (UHDRS - m) at 6 month intervals., Results: Nine patients were treated for 9.8 +/- 5.9 months. The mean OL dose/patient was 11.4 +/- 8.5 mg/day (median 10 mg/day). Mean CGIC was 2.1 +/- 0.8. UHDRS - b improved significantly (P < 0.0001) and UHDRS - m did not change. Chorea improved in five patients and two dropped out because of drug eruption and lack of efficacy., Conclusion: OL is a good alternative treatment in HD, mainly for the psychiatric symptoms and moderately effective for the motor symptoms, possibly because of its effect on chorea. We suggest OL should be used in HD patients with the adult onset form, severe chorea and/or severe psychiatric disturbances.