scholarly journals Behavioral and Psychological Symptoms in Dementia (BPSD) and the Use of Antipsychotics

2021 ◽  
Vol 14 (3) ◽  
pp. 246
Author(s):  
Valeria Calsolaro ◽  
Grazia Daniela Femminella ◽  
Sara Rogani ◽  
Salvatore Esposito ◽  
Riccardo Franchi ◽  
...  
Keyword(s):  
Serotonin Receptors ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Psychological Symptoms ◽  
Rebound Effect ◽  
Safety Issues ◽  
Second Generation Antipsychotics ◽  
Therapy Interruption ◽  
Dopamine And Serotonin Receptors ◽  
Behavioral And Psychological Symptoms

Dementia affects about 47 million people worldwide, number expected to exponentially increase within 30 years. Alzheimer’s disease (AD) is the most common dementia type, accounting on its own for almost 70% of all dementia cases. Behavioral and psychological symptoms (BPSD) frequently occur during the disease progression; to treat agitation, aggressiveness, delusions and hallucinations, the use of antipsychotic drugs should be limited, due to their safety issues. In this literature review regarding the use of antipsychotics for treating BPSD in dementia, the advantages and limitation of antipsychotic drugs have been evaluated. The available medications for the management of behavioral and psychological symptoms are the antipsychotics, classed into typical and atypical, depending on their action on dopamine and serotonin receptors. First generation, or typical, antipsychotics exhibit lack of tolerability and display a broad range of side effects such as sedation, anticholinergic effects and extrapyramidal symptoms. Atypical, or second generation, antipsychotics bind more selectively to dopamine receptors and simultaneously block serotonin receptors, resulting in higher tolerability. High attention should be paid to the management of therapy interruption or switch between antipsychotics, to limit the possible rebound effect. Several switching strategies may be adopted, and clinicians should “tailor” therapies, accounting for patients’ symptoms, comorbidities, polytherapies and frailty.

scholarly journals Treatment mechanisms: traditional and new antipsychotic drugs

2000 ◽  
Vol 2 (3) ◽  
pp. 281-286
Keyword(s):  
Side Effects ◽  
Animal Studies ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation Antipsychotics ◽  
Treatment Mechanisms ◽  
1960S And 1970S ◽  
The 1960S ◽  
Efficacy Profile ◽  
Equal Efficacy

The first generation of antipsychotic drugs was discovered in the 1960s and 1970s, These agents were effective in treating psychosis, but were accompanied by significant side effects, including severe parkinsonism and akathisia. Second-generation antipsychotics were introduced in the 1990s, These drugs have at least equal efficacy to their predecessors, but far fewer side effects. Some data suggest a broader efficacy profile. Clozapine remains the only superior antipsychotic in terms of the magnitude of psychotic symptom reduction. Clinical and animal studies are consistent in suggesting that the antipsychotic component of antidopaminergic treatments is initiated by dopamine receptor blockade in the striatum and that the signal is transmitted to the neocortex through the established basal ganglia-thalamo-cortical neuronal circuits. Other neurotransmitter actions (eg, antiserotonergic) can be exerted locally, in the neocortex. Defining tissue targets of drug action may suggest additional strategies for developing new antipsychotic drugs.

Recent development of piperazine and piperidine derivatives as antipsychotic agents

2020 ◽  
Vol 20 ◽  
Author(s):  
Akash Rathore ◽  
Vivek Asati ◽  
Sushil Kumar Kashaw ◽  
Shivangi Agarwal ◽  
Deepa Parwani ◽  
...  
Keyword(s):  
Serotonin Receptors ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Antipsychotic Agents ◽  
Anti Psychotic ◽  
Lead Compounds ◽  
Piperazine Derivatives ◽  
Structure Activity ◽  
Dopamine And Serotonin Receptors ◽  
Global Population

: Schizophrenia is a chronic neuropsychiatric disorder that affects nearly 1% of the global population. There are various anti-psychotic drugs available for the treatment of schizophrenia, but they have certain side effects, therefore there is a need to explore and develop novel potential lead compounds against schizophrenia. The currently available drugs e.g. typical and atypical antipsychotics act on different dopamine and serotonin receptors and as per literature reports, various piperidine and piperazine derivatives have shown promising activity against these receptors. When different heterocyclic groups are attached to basic piperidine and piperazine rings, the anti-psychotic activity is greatly potentiated. In this direction various antipsychotic drugs have been synthesized at laboratory level and few are under clinical trial studies such as Lu AE58054, PF-04802540, ORG25935, DMXB-A, Bitopertin and ABT-126. In the present review, we include the studies related to the effect of different substituents on piperidine/piperazine derivatives and their anti-psychotic activity. Various series of synthesized compounds by different researchers with piperidine/piperazine nucleus have been reviewed and diagrammatically represented in the form of SAR (structure activity relationships) which will help to the scientists for the development of potential lead compounds.

scholarly journals TREATMENT WITH ANTIPSYCHOTICS AND RISK OF DEATH IN 58,000 PATIENTS FROM SWEDISH DEMENTIA REGISTRY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S421-S421
Author(s):  
Dorota Religa ◽  
Emilia Schwertner ◽  
sara Garcia-ptacek ◽  
Bjorn Johansson ◽  
Katarina Nägga ◽  
...  
Keyword(s):  
Antipsychotic Drugs ◽  
Psychological Symptoms ◽  
Dementia Diagnosis ◽  
Educational Effort ◽  
Risk Of Death ◽  
Total Cohort ◽  
Dementia Patients ◽  
All Cause Mortality ◽  
Dementia Registry ◽  
Behavioral And Psychological Symptoms

Abstract Background: Behavioral and Psychological symptoms of Dementia (BPSD) are a heterogeneous group of clinical phenomena that is subjectively experienced by the patient and/or observable by an examiner (e.g., caregiver, physician) consisting in disturbed emotions, perception, thought, motor activity, and altered personality. There are recommendations to limit antipsychotic use in patients with dementia, and the big educational effort is made to follow them. In Sweden antipsychotics use changed from 10.1% in 2007-2008 to 5.2% in 2014-2015. Aims: The aim of the study is to analyze the actors associated with treatment and mortality of dementia patients, particularly those suffering from BPSD. Particularly we focus on assessing all-cause mortality patients with dementia treated with antipsychotic drugs (APDs). Methods: We have analyzed 58,412 patients newly diagnosed with dementia. We have found that 2526 of the patients were prescribed APDs (602 typical APDs and 1833 atypical APDs)- Results In the adjusted models, use of APDs at the time of dementia diagnosis was associated with increased mortality risk in the total cohort (hazard ratio = 1.4; 95% confidence interval 1.3-1.5). We have also stratified the results. Conclusions: The risk of death in patients with dementia was increased in group that used atypical and typical APDs. Our study gives more evidence to advice caution in APD prescription for patients with dementia.

scholarly journals A review of pharmacokinetic and pharmacodynamic interactions with antipsychotics

2016 ◽  
Vol 6 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Ruki Wijesinghe
Keyword(s):  
Drug Interactions ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Relevant Literature ◽  
Treatment Interventions ◽  
Pharmacodynamic Interactions ◽  
Common Drug ◽  
Second Generation Antipsychotics ◽  
Clinically Significant ◽  
Potential Interactions

Abstract Introduction Antipsychotics are widely used and often in combination with other drugs, thereby frequently subjected to drug-drug interactions. This review will provide a summary of potential pharmacokinetic (PK) and pharmacodynamic (PD) drug interactions associated with antipsychotic drugs. Methods A literature search was conducted for clinically significant drug interactions with antipsychotics. Results Most common PK drug interactions take place via the cytochrome P450 (CYP) system. PK profiles of first generation antipsychotics are inadequately studied; nevertheless most common drug interactions involve changes to their metabolic processes. Interactions with second generation antipsychotics are somewhat well-established, documented, and give some guidance for therapeutic treatment interventions. PD interactions occurring at the receptor level result in additive, synergistic, or antagonistic effects. Discussion This review summarizes a collection of relevant literature of significant PK and PD interactions occurring with antipsychotics. The involvement of multiple CYP enzymes makes it more difficult to predict the extent of the interaction and clinicians should take into consideration the timeline when evaluating potential interactions.

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