Bergh S, Engedal K. The withdrawal of antipsychotics and antidepressants from patients with dementia and BPSD living in nursing homes – an open pilot study. International Journal of Geriatric Psychiatry 2008;23:877–79-77–79
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/18655022
Full text article: https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.2008
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 23 enrolled
Age: 84.1 ± 6.59 years Sex: 21 female, 2 male Participants with dementia: Yes, all Inclusion criteria: · Living in NH for more than 3 months · CDR1 (CDR not defined) · Diagnosis of Alzheimer’s or vascular dementia · Using either antipsychotic or antidepressant drugs for more than 3 months Exclusion criteria: · Severe psychiatric disorder · Terminal somatic disease · Acute infection · Diabetes mellitus Country: Norway Setting: Residential aged care facilities |
| Interventions | Medicine: Antipsychotics and antidepressants
Withdrawal schedule: Tapered over one week |
| Outcomes | Neuropsychiatric Index
Cornell’s Depression Score Severe Impairment Battery Unified Parkinson Disease Rating Scale |
| Dates | Study dates: Not described
Follow-up duration: 24 weeks |
| Funding sources | Eastern Norway Regional Health Authority, project number 101 |
| Notes | The authors stated: “Conflict of interest: none known.” |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | Not randomized. |
| Allocation concealment (selection bias) | High risk | This was an open study. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | As above. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 5 out of 5 | It is an as-treated analysis without explained reasons for the missing data. |
| Selective reporting (reporting bias) | 3 out of 5 | The protocol was approved by a Human Research Ethics Committeethough it is unclear to what degree the authors adhered to a pre-specified analysis plan |
| Confounding (non-randomized) | 5 out of 5 | There was no control group. |
| Other bias | Unclear risk | Unclear as there is limited detail. |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | It is unclear as to what degree the exposed cohort is representative of a given population as there is limited detail. |
| Selection of the non-exposedcohort | There is no concurrent control group. | |
| Ascertainment of exposure | There is no description on how the researchers ascertained exposure. | |
| Demonstration that outcome of interest was not present at start of study | They demonstrated that the outcome of interest was not present at the start of the study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The studycontrols for medication withdrawal. |
| Outcome bias | Assessment of outcome | There is no description on how the outcome was assessed. |
| Was follow-up long enough for outcomes to occur
|
The follow-up period was likely adequate for outcomes of interest to occur. | |
| Adequacy of follow-up of cohorts | The follow-up of participants was adequate. | |
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