http://archinte.jamanetwork.com/ en-us Sat, 01 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:51:21 GMT Silverchair editor@archinte.jamanetwork.com webmaster@archinte.jamanetwork.com http://archinte.jamanetwork.com/article.aspx?articleID=1135403 Mon, 23 Apr 2012 00:00:00 GMT Gill SS, MD, MSc, Seitz DP, MD. <span class="paragraphSection">Antipsychotic medications are prescribed routinely to manage various neuropsychiatric symptoms in older adults with dementia. In recent years, atypical antipsychotics (eg, risperidone, olanzapine, and quetiapine fumarate) have essentially replaced older typical agents, such as haloperidol, in this setting. Although widespread use of antipsychotics to treat older persons with dementia persists, there has been increasing recognition of the serious adverse effects associated with these medications. In 2005, evidence emerged that antipsychotic treatment increased overall mortality among older adults with dementia. The increased risk for death associated with antipsychotic use has raised several important questions, and among them is the question of how exposure to these drugs leads to death.</span> 172 8 654 655 10.1001/archinternmed.2012.682 http://archinte.jamanetwork.com/article.aspx?articleID=1135403 http://archinte.jamanetwork.com/article.aspx?articleID=1135424 Mon, 23 Apr 2012 00:00:00 GMT Pariente A, MD, PhD, Fourrier-Réglat A, PharmD, PhD, Ducruet T, MSc, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>Antipsychotic agents (APs) are commonly prescribed to older patients with dementia. Antipsychotic use is associated with an increased risk of ischemic stroke in this population. Our study aimed to investigate the association of AP use with the risk of acute myocardial infarction (MI).<div class="boxTitle">Methods</div>A retrospective cohort of community-dwelling older patients who initiated cholinesterase inhibitor treatment was identified between January 1, 2000, and December 31, 2009, using the Quebec, Canada, prescription claims database. From this source cohort, all new AP users during the study period were matched with a random sample of AP nonusers. The risk of MI was evaluated using Cox proportional hazards models, adjusting for age, sex, cardiovascular risk factors, psychotropic drug use, and propensity scores. In addition, a self-controlled case series study using conditional Poisson regression modeling was conducted.<div class="boxTitle">Results</div>Among the source cohort of 37 138 cholinesterase inhibitor users, 10 969 (29.5%) initiated AP treatment. Within 1 year of initiating AP treatment, 1.3% of them had an incident MI. Hazard ratios for the risk of MI after initiation of AP treatment were 2.19 (95% CI, 1.11-4.32) for the first 30 days, 1.62 (95% CI, 0.99-2.65) for the first 60 days, 1.36 (95% CI, 0.89-2.08) for the first 90 days, and 1.15 (95% CI, 0.89-1.47) for the first 365 days. The self-controlled case series study conducted among 804 incident cases of MI among new AP users yielded incidence rate ratios of 1.78 (95% CI, 1.26-2.52) for the 1- to 30-day period, 1.67 (95% CI, 1.09-2.56) for the 31- to 60-day period, and 1.37 (95% CI, 0.82-2.28) for the 61- to 90-day period.<div class="boxTitle">Conclusion</div>Antipsychotic use is associated with a modest and time-limited increase in the risk of MI among community-dwelling older patients treated with cholinesterase inhibitors.</span> 172 8 648 653 10.1001/archinternmed.2012.28 http://archinte.jamanetwork.com/article.aspx?articleID=1135424