Meta-Analysis of the Effectiveness of Atypical Antipsychotics for the Treatment of Behavioural Problems in Persons with Dementia
Department of Psychology, University of Nevada, Reno, NV 89557, USA. Psychotherapy and Psychosomatics
(Impact Factor: 9.2).
02/2007; 76(4):213-8. DOI: 10.1159/000101499
To review published reports of the usage of atypical antipsychotics for behavioural problems of dementia patients.
The electronic database Medline was searched from 1999 to 2006 with a combination of search terms including 'behavioural problems' and 'atypical antipsychotics'.
Thirteen eligible studies were included in the overall analysis. The total number of participants was 1,683, of whom 1,015 received medication and 668 received placebo. Medications studied were risperidone, olanzapine, and quetiapine. Other studies examined other types of medications, such as typical versus atypical antipsychotics, but only data for atypical antipsychotics were included in the meta-analysis. The mean effect size for 7 placebo-controlled studies was 0.45 (95% CI = 0.16-0.74) for atypical antipsychotics, and 0.32 (95% CI = 0.10-0.53) for placebo. The mean effect size of all 13 studies included in the analysis was 0.31 (95% CI = 0.08-0.54).
In general, effect sizes of atypical antipsychotics for behavioural problems are medium, and there are no statistically or clinically significant differences between atypical antipsychotics and placebo.
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- "Such exclusive interventions, however, have less of an impact on patients' more disturbing psychotic symptoms. Historically, antipsychotic medications have been the first-line treatment for severe behavioral problems for dementia patients, which unfortunately tend to be disproportionately prescribed to elderly communities (Yury & Fisher, 2007). Because of the complicated nature of the inevitable progression of dementia and its concurrent treatment, psychological care has predominantly adopted person-centered therapies tailored specifically toward the patient's immediate emotional, behavioral, and environmental needs (Rayner et al., 2006). "
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ABSTRACT: The purpose of this study is to discern the relevant and effective components of existential and process-work approaches to the clinical treatment of elderly clients with dementia. This study explores how these specific humanistic and transpersonal approaches to this population’s presenting concerns represent unique alternatives to the mainstream medical model of dementia treatment that pejoratively frames dementia as a mental illness. Ten therapist interns at two of Pacific Institute’s assisted living facilities in San Francisco, CA, were interviewed using open-ended questions designed to elicit detailed accounts of their clinical work using these two therapeutic modalities. The interview transcripts were coded using a qualitative thematic analysis methodology and computer software assistance to identify prominent factors that influenced the therapy, including therapist attitudes, embodiments, clinical conceptualizations, interventions, and impediments to effective treatment. These research results systematically thematize the prominent aspects of existential and process-work approaches in working with older people with mild to advanced symptoms of dementia. It is hoped that this study will inform further exploration of these effective therapeutic modalities in diverse clinical populations and settings.
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