756: The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperidone and conventional antipsychotics Efficacy and Tolerability of Risperidone, Yokukansan, and Fluvoxamine for the Treatment of Behavioral and Psychological Symptoms of Dementia: A Blinded, Randomized Trial How to write an evidence-based clinical review article. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study. Adverse Effects and Laboratory Parameters of High-Dose Olanzapine vs. Clozapine in Treatment-Resistant Schizophrenia The assessment of thiothixene in chronic schizophrenia. A double-blind controlled trial.
BACKGROUND Acute extrapyramidal side effects ( EPS ) are a common phenomenon of treatment with conventional antipsychotics . Previous studies found that clozapine has little propensity to cause EPS , while risperidone produces some EPS , but at levels lower than those of conventional antipsychotics . METHOD We compared the prevalence and severity of EPS in patients treated with clozapine , risperidone , or conventional antipsychotics for at least 3 months . Our main hypothesis was that there would be differences between the three treatment groups with regard to akathisia , measured with the Barnes Akathisia Scale , and extrapyramidal motor side effects ( rigidity , rigidity factor , tremor , salivation ) , measured with the Simpson-Angus scale . Secondarily , we were interested in possible differences between the three groups with respect to the anticholinergic comedication and the subjective impression of the patients , measured with the van Putten scale . RESULTS We studied 106 patients ( 41 patients treated with clozapine , 23 patients with risperidone , and 42 patients treated with conventional antipsychotics ) . The sample was 57.5 % male and had a mean + /- SD age of 36.6 + /- 9.3 years . The mean dose of antipsychotics  calculated in chlorpromazine equivalents was 425.6 + /- 197.1 mg/day in the clozapine group , 4.7 + /- 2.1 mg/day in the risperidone group , and 476.5 + /- 476.9 mg/day in the group treated with conventional antipsychotics . The point-prevalence of akathisia was 7.3 % in the clozapine group , 13 % in the risperidone group , and 23.8 % in the group treated with conventional antipsychotics . The point-prevalence of rigidity and cogwheeling respectively was 4.9 % and 2.4 % in the clozapine group , 17.4 % and 17.4 % in the risperidone group , and 35.7 % and 26.2 % in the group treated with conventional antipsychotics . CONCLUSION Our results indicate that risperidone is superior to conventional neuroleptics in that it causes fewer EPS . In comparison to clozapine , risperidone produces EPS levels that are intermediate between clozapine and conventional antipsychotic drugs Abstract The descriptive term behavioral and psychological symptoms of dementia ( BPSD ) is used to cover a range of noncognitive disturbances including anxiety , depression , irritability , aggression , agitation , eating disorders , and inappropriate social or sexual behaviors . Behavioral and psychological symptoms of dementia are seen in about 90 % of patients with dementia . We aim ed to compare the efficacy and tolerability of risperidone , yokukansan , and fluvoxamine used for BPSD in elderly patients with dementia . Ninety in patients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria were investigated in Sato Hospital , Koutokukai . We conducted an 8-week , rater-blinded , r and omized trial , administering flexibly dosed risperidone , yokukansan , or fluvoxamine . Primary outcome measures were Neuropsychiatric Inventory in Nursing Home Version total score and its items . Secondary outcome measures were cognitive function measured by Mini-Mental State Examination and daily life function measured by Functional Independence Measure ( FIM ) . Neurological adverse effects were measured by the Drug-Induced Extra-Pyramidal Symptoms Scale . At the end of the study , we analyzed 76 patients ( 92.7 % ) .  Mean Neuropsychiatric Inventory in Nursing Home Version total score decreased in all 3 drug groups , with no significant between-group differences . Mini-Mental State Examination and Functional Independence Measure scores did not change significantly . Drug-Induced Extra-Pyramidal Symptoms Scale scores did not change in the yokukansan and fluvoxamine groups , but increased significantly in the risperidone group . Risperidone , yokukansan , and fluvoxamine were equally effective in the treatment of BPSD in elderly patients . However , yokukansan or fluvoxamine for BPSD showed a more favorable profile in tolerability compared with risperidone . This trial is registered at UMIN Clinical Trials Registry ( identifier : UMIN000006146 ) Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points BACKGROUND To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit . METHODS Observational prospect i ve cohort study with data collection based on clinical data bases and electronic clinical notes . All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31 , 2010 . All individuals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination . Main outcome measure was readmission for pneumonia . Clinical notes were review ed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia . RESULTS A total of 2,359 patients ( 61.9 % women , mean age 84.9 y ) were recruited and followed for a mean of 24 months . Dysphagia was diagnosed in 47.5 % of cases . Overall , 7.9 % of individuals were readmitted for pneumonia during follow-up , 24.2 % of these had aspiration pneumonia . The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years ( 95 % CI 3.0 - 4.4 ) in individuals without dysphagia and 6.7 ( 5.5 - 7.8 ) in those with dysphagia , with an attributable risk of 3.02 readmissions per 100 person-years ( 1.66 - 4.38 ) and a rate ratio of 1.82 ( 1.41 - 2.36 ) . Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia , with a hazard ratio of 1.6 ( 1.15 - 2.2 ) for hospitalization for pneumonia , 4.48 ( 2.01 - 10.0 ) for aspiration pneumonia , and 1.44 ( 1.02 - 2.03 ) for nonaspiration pneumonia . CONCLUSION Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons Patients with treatment-resistant schizophrenia pose a major challenge to caregivers since only clozapine is documented as having superior efficacy in this population . Although olanzapine is similar to clozapine in structure and receptor profile , it has not been proven to have superior efficacy for this patient group . Nonetheless , olanzapine is being increasingly used in higher doses as clinicians attempt to find a more effective and tolerable therapy for refractory patients . Furthermore , there are little data comparing olanzapine and clozapine in this population . Thirteen patients participated in a r and omized double-blind 16-week crossover study of  clozapine therapy ( 450 mg/day ) compared to high doses of olanzapine ( 50 mg/day ) . No patients on olanzapine responded while 20 % responded to clozapine treatment . Olanzapine patients tended to experience higher rates of anticholinergic effects such as dry mouth ( 80 vs. 20 % ) and blurry vision ( 40 vs. 0 % ) . Clozapine-treated patients had higher rates of sialorrhea ( 80 vs. 10 % ) , sweating ( 50 vs. 10 % ) , dyspepsia ( 70 vs. 30 % ) , and lethargy ( 90 vs. 60 % ) . Neither treatment was associated with significant akathisia . Liver enzyme elevation and lipids were higher with clozapine treatment . Mean weight gain in the initial 8 weeks was 3.4 kg for olanzapine and 1.2 kg for clozapine . High doses of olanzapine during 8 weeks of treatment did not increase lipids and liver enzymes like clozapine did . Olanzapine at 50 mg/day may be associated with more anticholinergic effects and weight gain than clozapine The results are reported of a double-blind controlled trial of a recently introduced major tranquilizer thiothixene ( Navane , Pfizer ) against chlorpromazine in 24 chronic schizophrenics in the Royal Edinburgh Hospital , Edinburgh , Scotl and . Additionally , a limited experiment in withdrawal of routine  tranquilizers in these patients ( one month ) was carried out prior to the trial . Changes in manifest psychosis ( symptoms ) and social disability were assessed by the use of the Lorr scale ( IMPS ) and the Nurses ' Observation Scale for Inpatient Evaluation ( NOSIE ) at suitable intervals . The results indicated that thiothixene conferred no advantage over chlorpromazine in symptom relief or social improvement . Serial measures showed no significant change in these patients as a group when on active drugs as opposed to placebo , or with the course of time . 12.5 % of patients relapsed during the placebo period : these patients were younger than the non-relapsers and had received larger daily doses of phenothiazines prior to the trial
The association between antipsychotics ( also known as neuroleptics ) and oropharyngeal dysphagia ( OD ) has been suggested in several case reports .
The purpose of this systematic review was to examine the effect of antipsychotic medication on OD .