A meta-analysis on the efficacy and safety of risperidone in patients with Behavioral and Psychological Symptoms of Dementia (BPSD)

OBJECTIVE: To determine the efficacy and safety of risperidone compared to placebo and haloperidol in the treatment of behavioral and psychological symptoms of dementia. METHODOLOGY: In a systematic review of literature, all articles published from January 1990 - September 2005 that conducted double-blind, randomized controlled clinical trials evaluating the efficacy and safety of risperidone and haloperidol for the treatment of BPSD were selected. The search was performed by means of MEDLINE, PUBMED, Cochrane Library database limited to studies written in English from 1990 to 2005. Key journals and textbooks were also searched in addition to the electronic database search. References mentioned in these studies were likewise reviewed. Two reviewers independently did validity assessment. Analysis of data was done by statistical packs Revman 4.2.7 from Cochrane Collaboration and SPSS (statistical package for the social sciences) v 9.0. RESULTS: Five trials were included in this study. A total of 964 patients were evaluated. Risperidone was superior to placebo as evidenced by significant reduction in the scores of total BEHAVE-AD score (WMD = 2.97, 95% CI = 1.65 - 4.29), BEHAVE-AD aggression subscale (WMD = 1.40, 95% CI = 1.34 - 1.46), and CMAI total aggression subscale (WMD = 3.82, 95% CI = 3.04 - 4.60). Comparison of risperidone and haloperidol showed significant reduction in the total BEHAVE- AD score in patients receiving risperidone (WMD = 1.80, 95% CI = 0.43 - 3.18). Comparing the odds ratio of having an adverse effect, analysis revealed greater chance of developing somnolence (OR = 1.88, 95% CI = 1.27 - 2.77), peripheral edema (OR = 2.43, 95% CI = 1.29 - 4.59) and extrapyramidal symptoms (OR = 1.93, 95% CI = 1.04 - 3.61) with risperidone. CONCLUSION: Risperidone is effective and relatively safe in the treatment of behavioral and psychological symptoms of dementia. Higher incidence of somnolence, peripheral edema and extrapyramidal symptoms was noted with risperidone compared to placebo. Compared with haloperidol, risperidone was superior in the total BEHAVE- AD scale and showed more favorable results in the total CMAI scale, BEHAVE-AD aggression and CMAI total aggression subscales.

Alcohol use disorder among elderly non-psychiatric inpatients in a tertiary general hospital

OBJECTIVE: To determine the prevalence of alcoholic use disorder among elderly non-psychiatric inpatients in a tertiary hospital and the ability of the medical staff to identify alcoholism among this specific population.METHODOLOGY: This is a cross-sectional analytic study. Inpatients aged 65 and above were drawn from a tertiary general hospital. The Tagalog edition of the Short Michigan Alcoholism Screening Test-Geriatric version (SMAST-G) was administered to these subjects. The screened positive respondents were classified as non-hazardous, hazardous and harmful drinkers. They were also classified as either alcohol abusers or dependents based on DSM-IV-TR. The ability of the medical staff to identify alcoholism was assessed by interviewing the attending physician and reviewing the medical records of the patients.RESULTS: The overall prevalence rate of alcoholic use disorder among elderly non-psychiatric inpatients was 18.5%, with male respondents comprising 83.3%. A strong association was observed between elderly alcohol use and male gender, higher educational attainment, age less than 75, married status, smoking status, current employment and past manual occupation. The identification rate of medical staff was computed at 41.7%, with internal medicine physicians detecting the most number of cases.CONCLUSION: Approximately one-fifth of elderly inpatients has alcohol use disorder and has been neglected substantially by the medical staff.