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Antipsychotic Use and Community-Acquired Pneumonia FREE

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The summary below is from the full report titled “Association of Community-Acquired Pneumonia With Antipsychotic Drug Use in Elderly Patients. A Nested Case–Control Study.” It is in the 6 April 2010 issue of Annals of Internal Medicine (volume 152, pages 418-425). The authors are G. Trifirò, G. Gambassi, E.F. Sen, A.P. Caputi, V. Bagnardi, J. Brea, and M.C.J.M. Sturkenboom.

Ann Intern Med. 2010;152(7):I-20. doi:10.7326/0003-4819-152-7-201004060-00002
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What is the problem and what is known about it so far?

Antipsychotics are a group of drugs typically used to control symptoms of psychosis. Types of antipsychotics include older, first-generation “typical” agents and newer, second-generation “atypical” agents. Both types are approved by the U.S. Food and Drug Administration for treatment of bipolar disorder, mania, and schizophrenia. Neither type is approved for treatment of behavioral disorders in patients with dementia or for dementia-related psychosis, although doctors sometimes prescribe them for such problems.

Several recent studies suggest that use of antipsychotics in elderly people with dementia is associated with important risks, including increased risk for diabetes, stroke, pneumonia, and death. The studies that specifically examined risk for pneumonia focused mainly on patients hospitalized with that condition.

Why did the researchers do this particular study?

To learn whether elderly people living in the community who are taking an antipsychotic drug have an increased risk for pneumonia.

Who was studied?

Older adults living in the community who received a prescription for an antipsychotic. Many had dementia-related psychosis, behavioral disorders, or anxiety disorders. Few had schizophrenia.

How was the study done?

The researchers searched electronic records in a database of Dutch patients followed by general practitioners. They identified adults aged 65 years or older who received a prescription for an antipsychotic between 1996 and 2006. They selected all such patients with diagnoses of pneumonia (case patients). For each case patient, they also selected up to 20 control participants without pneumonia. They then compared the timing of use, type, and dose of the antipsychotic between case patients and control participants.

What did the researchers find?

Compared with past use, current use of antipsychotics was associated with increased risk for pneumonia. Both atypical and typical antipsychotics were associated with increased risk. Higher doses were associated with greater risk than were lower doses. The highest risk for pneumonia was during the first week of treatment.

What were the limitations of the study?

The researchers did not know whether patients actually took their prescribed medicines. In addition, they did not study elderly people living in nursing homes or long-term care facilities.

What are the implications of the study?

Typical and atypical antipsychotics in elderly people seem to be associated with increased risk for community-acquired pneumonia.





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