Antipsychotics Increase Mortality Risk in Older Adults With Bipolar Disorder

[Guest guest]

I've often wondered why ONLY elderly patients with dementia,

obviously a subjective condition, were at risk of death from

antipsychotics. Well finally the truth slowly comes out, probably

at the pace the drugs can no longer make billions, that there are

other conditions early death can be assigned to with these very

harsh drugs. I am still waiting for the obvious announcement that

these drugs kill elderly off no matter what!

http://www.internalmedicinenews.com/news/geriatric-medicine/single-article/antipsychotics-increase-mortality-risk-in-older-adults-with-bipolar-disorder/f082cd78e5.html

Antipsychotics Increase Mortality Risk in Older Adults With

Bipolar Disorder

By: NEIL OSTERWEIL, Internal Medicine News

Digital Network

SAN ANTONIO – Older adults with bipolar disorder

who receive antipsychotic agents are at increased risk for death,

compared with those who received the mood stabilizer valproate,

investigators reported at the annual meeting of the American

Association for Geriatric Psychiatry.

A review of Veterans Affairs data on 4,854

patients aged 65 and older with bipolar disorder showed that the

risk of death within 180 days of receiving an antipsychotic

prescription was highest for haloperidol, followed by risperidone,

olanzapine, and quetiapine; valproate was associated with the

lowest excess risk, according to Dr. Sachin J. Bhalerao, a

second-year psychiatry resident at the University of Michigan, Ann

Arbor, and his colleagues.

"Although antipsychotics are FDA approved for

use in bipolar disorder (unlike with the neuropsychiatric symptoms

of dementia), our data indicate that they should be used

judiciously when traditional mood stabilizers and psychosocial

interventions and psychotherapies do not fully address the

patient’s needs," they wrote in a poster presentation.

The investigators looked at VA data on 4,854

adults 65 and older with a new medication start of haloperidol,

risperidone, olanzapine, quetiapine, or valproate, no history of

antipsychotic or anticonvulsant use in the previous year,

monotherapy during 180-day follow-up, and for valproate users, no

concurrent seizure disorders.

About one-third of the sample (35.1%) took

valproate, followed by quetiapine (23%), risperidone (21.2%),

olanzapine (17.9%), and haloperidol (2.8%). Although the

demographics of the various drug groups were generally similar,

the haloperidol group had a higher proportion of African Americans

and unmarried people than the other groups. Patients on

haloperidol also had more medical comorbidities than others, as

well as higher rates of comorbid dementia, delirium, and substance

abuse.

During 6-month follow-up, there were 21 deaths

among 137 patients on haloperidol (15.3%), 68 among 1,027 on

risperidone (6.6%), 43 among 868 on olanzapine (5%), 29 among

1,119 on quetiapine (2.6%), and 38 among 1,703 on valproate

(2.2%).

In covariate-adjusted exposure and

intent-to-treat models, the relationship between drug type and

mortality remained essentially the same, with haloperidol users at

highest risk (relative risk, 1.31), followed by risperidone

(reference), olanzapine (RR, 0.75), valproate (RR, 0.42), and

quetiapine (RR, 0.28).

Although the mechanism by which antipsychotic

agents might increase the risk of death in the elderly is unknown,

"a growing body of evidence suggests that antipsychotics increase

mortality risk in both elderly dementia and nondementia

populations," the investigators wrote. "This may be interpreted to

indicate that the link to mortality in these conditions has less

to do with the particular psychiatric condition or underlying

brain pathology (for example, in dementia) and more to do with age

and associated medical comorbidity."

The study was supported by a National Institute

of Mental Health grant to principal investigator, Dr. Helen C.

Kales. The authors had no conflict of interest disclosures.

[Guest guest]

I've often wondered why ONLY elderly patients with dementia,

obviously a subjective condition, were at risk of death from

antipsychotics. Well finally the truth slowly comes out, probably

at the pace the drugs can no longer make billions, that there are

other conditions early death can be assigned to with these very

harsh drugs. I am still waiting for the obvious announcement that

these drugs kill elderly off no matter what!

http://www.internalmedicinenews.com/news/geriatric-medicine/single-article/antipsychotics-increase-mortality-risk-in-older-adults-with-bipolar-disorder/f082cd78e5.html

Antipsychotics Increase Mortality Risk in Older Adults With

Bipolar Disorder

By: NEIL OSTERWEIL, Internal Medicine News

Digital Network

SAN ANTONIO – Older adults with bipolar disorder

who receive antipsychotic agents are at increased risk for death,

compared with those who received the mood stabilizer valproate,

investigators reported at the annual meeting of the American

Association for Geriatric Psychiatry.

A review of Veterans Affairs data on 4,854

patients aged 65 and older with bipolar disorder showed that the

risk of death within 180 days of receiving an antipsychotic

prescription was highest for haloperidol, followed by risperidone,

olanzapine, and quetiapine; valproate was associated with the

lowest excess risk, according to Dr. Sachin J. Bhalerao, a

second-year psychiatry resident at the University of Michigan, Ann

Arbor, and his colleagues.

"Although antipsychotics are FDA approved for

use in bipolar disorder (unlike with the neuropsychiatric symptoms

of dementia), our data indicate that they should be used

judiciously when traditional mood stabilizers and psychosocial

interventions and psychotherapies do not fully address the

patient’s needs," they wrote in a poster presentation.

The investigators looked at VA data on 4,854

adults 65 and older with a new medication start of haloperidol,

risperidone, olanzapine, quetiapine, or valproate, no history of

antipsychotic or anticonvulsant use in the previous year,

monotherapy during 180-day follow-up, and for valproate users, no

concurrent seizure disorders.

About one-third of the sample (35.1%) took

valproate, followed by quetiapine (23%), risperidone (21.2%),

olanzapine (17.9%), and haloperidol (2.8%). Although the

demographics of the various drug groups were generally similar,

the haloperidol group had a higher proportion of African Americans

and unmarried people than the other groups. Patients on

haloperidol also had more medical comorbidities than others, as

well as higher rates of comorbid dementia, delirium, and substance

abuse.

During 6-month follow-up, there were 21 deaths

among 137 patients on haloperidol (15.3%), 68 among 1,027 on

risperidone (6.6%), 43 among 868 on olanzapine (5%), 29 among

1,119 on quetiapine (2.6%), and 38 among 1,703 on valproate

(2.2%).

In covariate-adjusted exposure and

intent-to-treat models, the relationship between drug type and

mortality remained essentially the same, with haloperidol users at

highest risk (relative risk, 1.31), followed by risperidone

(reference), olanzapine (RR, 0.75), valproate (RR, 0.42), and

quetiapine (RR, 0.28).

Although the mechanism by which antipsychotic

agents might increase the risk of death in the elderly is unknown,

"a growing body of evidence suggests that antipsychotics increase

mortality risk in both elderly dementia and nondementia

populations," the investigators wrote. "This may be interpreted to

indicate that the link to mortality in these conditions has less

to do with the particular psychiatric condition or underlying

brain pathology (for example, in dementia) and more to do with age

and associated medical comorbidity."

The study was supported by a National Institute

of Mental Health grant to principal investigator, Dr. Helen C.

Kales. The authors had no conflict of interest disclosures.

[Guest guest]

I've often wondered why ONLY elderly patients with dementia,

obviously a subjective condition, were at risk of death from

antipsychotics. Well finally the truth slowly comes out, probably

at the pace the drugs can no longer make billions, that there are

other conditions early death can be assigned to with these very

harsh drugs. I am still waiting for the obvious announcement that

these drugs kill elderly off no matter what!

http://www.internalmedicinenews.com/news/geriatric-medicine/single-article/antipsychotics-increase-mortality-risk-in-older-adults-with-bipolar-disorder/f082cd78e5.html

Antipsychotics Increase Mortality Risk in Older Adults With

Bipolar Disorder

By: NEIL OSTERWEIL, Internal Medicine News

Digital Network

SAN ANTONIO – Older adults with bipolar disorder

who receive antipsychotic agents are at increased risk for death,

compared with those who received the mood stabilizer valproate,

investigators reported at the annual meeting of the American

Association for Geriatric Psychiatry.

A review of Veterans Affairs data on 4,854

patients aged 65 and older with bipolar disorder showed that the

risk of death within 180 days of receiving an antipsychotic

prescription was highest for haloperidol, followed by risperidone,

olanzapine, and quetiapine; valproate was associated with the

lowest excess risk, according to Dr. Sachin J. Bhalerao, a

second-year psychiatry resident at the University of Michigan, Ann

Arbor, and his colleagues.

"Although antipsychotics are FDA approved for

use in bipolar disorder (unlike with the neuropsychiatric symptoms

of dementia), our data indicate that they should be used

judiciously when traditional mood stabilizers and psychosocial

interventions and psychotherapies do not fully address the

patient’s needs," they wrote in a poster presentation.

The investigators looked at VA data on 4,854

adults 65 and older with a new medication start of haloperidol,

risperidone, olanzapine, quetiapine, or valproate, no history of

antipsychotic or anticonvulsant use in the previous year,

monotherapy during 180-day follow-up, and for valproate users, no

concurrent seizure disorders.

About one-third of the sample (35.1%) took

valproate, followed by quetiapine (23%), risperidone (21.2%),

olanzapine (17.9%), and haloperidol (2.8%). Although the

demographics of the various drug groups were generally similar,

the haloperidol group had a higher proportion of African Americans

and unmarried people than the other groups. Patients on

haloperidol also had more medical comorbidities than others, as

well as higher rates of comorbid dementia, delirium, and substance

abuse.

During 6-month follow-up, there were 21 deaths

among 137 patients on haloperidol (15.3%), 68 among 1,027 on

risperidone (6.6%), 43 among 868 on olanzapine (5%), 29 among

1,119 on quetiapine (2.6%), and 38 among 1,703 on valproate

(2.2%).

In covariate-adjusted exposure and

intent-to-treat models, the relationship between drug type and

mortality remained essentially the same, with haloperidol users at

highest risk (relative risk, 1.31), followed by risperidone

(reference), olanzapine (RR, 0.75), valproate (RR, 0.42), and

quetiapine (RR, 0.28).

Although the mechanism by which antipsychotic

agents might increase the risk of death in the elderly is unknown,

"a growing body of evidence suggests that antipsychotics increase

mortality risk in both elderly dementia and nondementia

populations," the investigators wrote. "This may be interpreted to

indicate that the link to mortality in these conditions has less

to do with the particular psychiatric condition or underlying

brain pathology (for example, in dementia) and more to do with age

and associated medical comorbidity."

The study was supported by a National Institute

of Mental Health grant to principal investigator, Dr. Helen C.

Kales. The authors had no conflict of interest disclosures.

[Guest guest]

I've often wondered why ONLY elderly patients with dementia,

obviously a subjective condition, were at risk of death from

antipsychotics. Well finally the truth slowly comes out, probably

at the pace the drugs can no longer make billions, that there are

other conditions early death can be assigned to with these very

harsh drugs. I am still waiting for the obvious announcement that

these drugs kill elderly off no matter what!

http://www.internalmedicinenews.com/news/geriatric-medicine/single-article/antipsychotics-increase-mortality-risk-in-older-adults-with-bipolar-disorder/f082cd78e5.html

Antipsychotics Increase Mortality Risk in Older Adults With

Bipolar Disorder

By: NEIL OSTERWEIL, Internal Medicine News

Digital Network

SAN ANTONIO – Older adults with bipolar disorder

who receive antipsychotic agents are at increased risk for death,

compared with those who received the mood stabilizer valproate,

investigators reported at the annual meeting of the American

Association for Geriatric Psychiatry.

A review of Veterans Affairs data on 4,854

patients aged 65 and older with bipolar disorder showed that the

risk of death within 180 days of receiving an antipsychotic

prescription was highest for haloperidol, followed by risperidone,

olanzapine, and quetiapine; valproate was associated with the

lowest excess risk, according to Dr. Sachin J. Bhalerao, a

second-year psychiatry resident at the University of Michigan, Ann

Arbor, and his colleagues.

"Although antipsychotics are FDA approved for

use in bipolar disorder (unlike with the neuropsychiatric symptoms

of dementia), our data indicate that they should be used

judiciously when traditional mood stabilizers and psychosocial

interventions and psychotherapies do not fully address the

patient’s needs," they wrote in a poster presentation.

The investigators looked at VA data on 4,854

adults 65 and older with a new medication start of haloperidol,

risperidone, olanzapine, quetiapine, or valproate, no history of

antipsychotic or anticonvulsant use in the previous year,

monotherapy during 180-day follow-up, and for valproate users, no

concurrent seizure disorders.

About one-third of the sample (35.1%) took

valproate, followed by quetiapine (23%), risperidone (21.2%),

olanzapine (17.9%), and haloperidol (2.8%). Although the

demographics of the various drug groups were generally similar,

the haloperidol group had a higher proportion of African Americans

and unmarried people than the other groups. Patients on

haloperidol also had more medical comorbidities than others, as

well as higher rates of comorbid dementia, delirium, and substance

abuse.

During 6-month follow-up, there were 21 deaths

among 137 patients on haloperidol (15.3%), 68 among 1,027 on

risperidone (6.6%), 43 among 868 on olanzapine (5%), 29 among

1,119 on quetiapine (2.6%), and 38 among 1,703 on valproate

(2.2%).

In covariate-adjusted exposure and

intent-to-treat models, the relationship between drug type and

mortality remained essentially the same, with haloperidol users at

highest risk (relative risk, 1.31), followed by risperidone

(reference), olanzapine (RR, 0.75), valproate (RR, 0.42), and

quetiapine (RR, 0.28).

Although the mechanism by which antipsychotic

agents might increase the risk of death in the elderly is unknown,

"a growing body of evidence suggests that antipsychotics increase

mortality risk in both elderly dementia and nondementia

populations," the investigators wrote. "This may be interpreted to

indicate that the link to mortality in these conditions has less

to do with the particular psychiatric condition or underlying

brain pathology (for example, in dementia) and more to do with age

and associated medical comorbidity."

The study was supported by a National Institute

of Mental Health grant to principal investigator, Dr. Helen C.

Kales. The authors had no conflict of interest disclosures.