Propranolol for the management of behavioural and psychological symptoms of dementia.

Propranolol is a ß-adrenergic antagonist used in the management of hypertension, cardiac arrhythmia, and angina pectoris. There is some evidence that propranolol may benefit individuals with behavioural and psychological symptoms of dementia (BPSD). A total of three case series, one randomized controlled trial and one case report were identified (from a literature search of three major databases: PubMed, Ovid, and Cochrane collaboration) that assessed the use of propranolol for the management of BPSD. From these studies, it appears that propranolol improves BPSD, including agitation and aggression. Propranolol is also well tolerated with no significant bradycardia or hypotension noted in these studies. Current data on the use of propranolol for the management of BPSD are limited in comparison to other pharmacological agents (atypical antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, and cannabinoids) and treatment modalities (repetitive transcranial magnetic stimulation and electroconvulsive therapy). The efficacy and safety of these treatments among individuals with BPSD has been evaluated in multiple controlled studies. In clinical practice, the routine use of propranolol among people with BPSD cannot be recommended at this time given the limited data. However, propranolol can be trialled among individuals with BPSD when symptoms have not responded adequately to other medications. Propranolol may also be used prior to embarking on trials of repetitive transcranial magnetic stimulation and electroconvulsive therapy among people with BPSD given the greater acceptance of this medication in the general population.

Prazosin for the management of behavioural and psychological symptoms of dementia.

Prazosin, a centrally acting α1 adrenoceptor antagonist, has been included in two published algorithms amongst the list of medications that may be used in the management of behavioural and psychological symptoms of dementia (BPSD). However, a review of PubMed, Ovid and Cochrane Collaboration found that there was only one small published randomized controlled trial (RCT) that evaluated the use of prazosin amongst individuals with BPSD. Evidence from this good quality RCT indicates that prazosin appears to benefit individuals with agitation and aggression amongst individuals with BPSD and this medication is well tolerated. When compared to other treatments for BPSD, including atypical antipsychotics, antidepressants, acetylcholinesterase inhibitors, memantine, repetitive transcranial magnetic stimulation and electroconvulsive therapy, where there are multiple studies for each of these treatment modalities, the data for the use of prazosin for BPSD are limited to just one good quality RCT. Given the limitations in available data, the routine use of prazosin for the treatment of BPSD cannot be recommended at this time. However, prazosin may be used for the management of agitation and aggression amongst individuals with dementia when other medication classes, like acetylcholinesterase inhibitors, memantine, antidepressants and/or atypical antipsychotics, have been ineffective or not tolerated.

Systematic review of benzodiazepines for anxiety disorders in late life.

BACKGROUND: Benzodiazepines are currently the most commonly prescribed medication for the treatment of anxiety in older adults, although there is a dearth of good-quality data on this subject. The aim of this review was to systematically review studies examining the efficacy and tolerability of benzodiazepines for the treatment of anxiety disorders among older adults. METHODS: The authors conducted a systematic review, searching PubMed, Ovid MEDLINE, Ovid Embase, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. All searches were limited to English-language articles. The quality of each study was appraised using criteria developed by the Centre for Evidence-Based Medicine for randomized controlled trials. RESULTS: A total of 8,785 citations were retrieved and pooled in EndNote and de-duplicated to 3,753. This set was uploaded to Covidence for screening. Two separate screeners (AG and SAF) evaluated the titles, abstracts, and full text of the eligible articles. Five studies met the inclusion criteria. Across all studies, benzodiazepines were associated with decreased anxiety at the end of the study period. The limited tolerability data show mild adverse effects from the benzodiazepines studied. Limitations of the trials included limited data on the long-term use of benzodiazepines for anxiety and a preponderance of trials examining generalized anxiety disorder, with relatively less data on other anxiety disorders. CONCLUSIONS: Benzodiazepines are effective for treating anxiety disorders in late life, at least in the short term, but more data is needed to establish tolerability and their long-term benefits.

Anticonvulsants as monotherapy or adjuncts to treat alcohol withdrawal: A systematic review.

BACKGROUND: This systematic review evaluates current literature on anticonvulsants to treat alcohol withdrawal symptoms (AWS). METHODS: We performed a literature search of PubMed, MEDLINE, PsycINFO, EMBASE, and Cochrane collaboration databases through September 30, 2016. The search was not restricted by patients' age. Articles published in English or with official English translations were included. RESULTS: We found 16 double-blind randomized controlled trials (RCTs) that evaluated the use of anticonvulsants as treatment of AWS. Available data indicates that anticonvulsants are as effective as sedatives/hypnotics in treating mild or moderate AWS. Two studies evaluated the use of anticonvulsants as adjuncts. Combining anticonvulsants with sedatives decreases the quantity of sedatives required and AWS may resolve quicker. There is some data that anticonvulsants can be used to treat AWS as monotherapy. Fourteen of these studies assessed adverse effects of these medications; 13 studies identified minor adverse effects and one found the adverse effects to be intolerable. CONCLUSIONS: Available evidence indicates that anticonvulsants have good efficacy as monotherapy and as adjuncts with sedatives/hypnotics in treating mild to moderate AWS.

Use of cariprazine in psychiatric disorders: A systematic review.

BACKGROUND: Cariprazine was approved for treating schizophrenia and bipolar disorder, and currently is being evaluated for treating depression in clinical trials in the United States. We systematically reviewed the literature on the efficacy and safety of cariprazine. METHODS: We performed a literature search of the PubMed, MEDLINE, PsycINFO, EMBASE, and Cochrane collaboration databases through August 31, 2016. The search was not restricted by patient age. Articles published in English or official English translations were included. RESULTS: Eleven articles that evaluated the use of cariprazine in the treatment of psychiatric disorders were identified. Four trials evaluated the safety and efficacy of cariprazine in bipolar disorder. One trial investigated its use as an adjunct to antidepressants in major depressive disorder. Three trials evaluated its use in the treatment of acute exacerbations of schizophrenia. Two studies used risperidone or aripiprazole as comparators. Both low- and high-dose cariprazine were more effective than placebo in the treatment of acute mania, mixed episodes, and acute psychosis. Additionally, cariprazine showed efficacy as an adjunctive treatment for depression. CONCLUSIONS: Our review indicates that cariprazine demonstrates superior efficacy and good tolerability, both at low and high doses, in the treatment of individuals with psychosis, mania, and depression.

Is ondansetron beneficial for psychosis associated with dementia?.

BACKGROUND: This systematic review identified published studies that evaluated the use of ondansetron in individuals with psychosis associated with dementia. METHODS: A literature search was conducted of PubMed, MEDLINE, EMBASE, PsycINFO, and Cochrane Collaboration databases for randomized controlled trials (RCTs), cohort studies, and case reports that evaluated the use of ondansetron for individuals with psychosis associated with dementia. Bibliographic databases of published articles were also searched for additional studies. RESULTS: A total of 4 studies were identified, all of which were open-label trials of ondansetron for psychosis associated with Parkinson's disease. All trials showed improvements in visual hallucinations and paranoid ideations in most patients, as well as a modest improvement in functioning, but no evidence of cognitive improvement. CONCLUSIONS: Ondansetron appears to have benefit in improving positive symptoms of psychosis in individuals with Parkinson's disease, but RCTs are needed before routine use is recommended. There is a paucity of evidence for the use of ondansetron for psychosis associated with other forms of dementia.