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Pharmacopsychiatry
DOI: 10.1055/a-2336-3317
Original Paper

A Trajectory of Long-Term Antipsychotic Medication Dosage in Inpatients with Severe Behavioral and Psychological Symptoms of Dementia: A Retrospective Study

Teruo Tada
1   Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Mitaka-shi, Tokyo, Japan
,
Takefumi Suzuki
2   Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Chuo-shi, Yamanashi, Japan
,
Yusuke Iwata
2   Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Chuo-shi, Yamanashi, Japan
,
Masaharu Kubota
3   Department of Neuropsychiatry, Kusakabe Memorial Hospital, Yamanashi-shi, Yamanashi, Japan
,
Koichiro Watanabe
1   Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Mitaka-shi, Tokyo, Japan
,
Hitoshi Sakurai
1   Department of Neuropsychiatry, Kyorin University Faculty of Medicine, Mitaka-shi, Tokyo, Japan
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Abstract

Introduction While antipsychotics are often prescribed for behavioral and psychological symptoms of dementia (BPSD), typically on an off-label basis, these medications have serious adverse effects. This study investigated the long-term use of antipsychotics among inpatients with dementia displaying severe BPSD, focusing on how prescriptions change over time.

Methods Medical charts at Kusakabe Memorial Hospital were retrospectively reviewed from October 2012 to September 2021. The study included patients diagnosed with dementia, admitted for BPSD, and were continuing antipsychotics at 3 months of their admission. Antipsychotic dosages were categorized as high (≥300 mg/d), medium (100–300 mg/d), and low (<100 mg/d) based on chlorpromazine equivalents and tracked until 15 months during hospitalization. Binary logistic regression was used to identify factors associated with dosage reductions between months 3 and 6.

Results This study involved 188 patients, with an average age of 81.2 years, 67% of whom were diagnosed with Alzheimer&apos;s dementia. At 3 months, 15.4% were taking high, 44.1% on medium, and 40.4% on low dosages of antipsychotics. The highest average dosage was observed at 3 months, with a subsequent decrease over time. By the 12th month, 20–30% of patients in all dosage categories had stopped their antipsychotic medication. Significant factors for dosage reduction included higher initial doses (OR 1.003, 95%Cl: 1.001–1.006, P=0.01) and male gender (OR 2.481, 95%Cl: 1.251–4.918, P=0.009).

Discussion A trajectory of antipsychotic dosage in inpatients with severe BPSD has rarely been reported. This research emphasizes the need for personalized strategies in managing long-term pharmacotherapy for this vulnerable group of patients.

Keywords

antipsychotics - behavioral and psychological symptoms of dementia - dose - hospitalization - long-term

Supplementary Material



Publication History

Received: 04 March 2024
Received: 26 April 2024

Accepted: 26 May 2024

Article published online:
25 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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