Psychotropic drug use in older people with mental illness with particular reference to antipsychotics: a systematic study of tolerability and use in different diagnostic groups.

OBJECTIVE: The objective of the study was to provide observational clinical data on psychotropic drugs used in older people with mental illness. METHODS: This was an observational, single-centre, one-week prevalence study of psychiatric symptoms, disorders and psychotropic drug use in older with mental illness cared for by the South West people Yorkshire Mental Health NHS Trust (Wakefield Locality), UK. The clinical assessment included completion of the Psychosis Evaluation Tool for Common use by Caregivers. RESULTS: A total of 593/660 older patients with mental illness (mean +/- SD age, 76 +/- 8.1 years were assessed. 44.5% had dementia (excluding vascular dementia) and 33.7% had a mood disorder. Of the total, 20.4% did not receive CNS active medication. Of those receiving CNS active medication approximately half (51.3%) took antipsychotics and 46.2% antidepressants. Of 304 patients taking antipsychotics, 87% took only one medication. However, patients with schizophrenia and related disorders were significantly more likely to be prescribed two or more antipsychotics (p < 0.001). Risperidone was the most frequently prescribed antipsychotic (n = 136, 44.7%). Risperidone doses were significantly lower for patients with dementia and mood disorders than with schizophrenia (p < 0.002). Side-effects from antipsychotics were significantly greater in patients with schizophrenia, suggesting a dose-related effect. Risperidone appeared to be well tolerated in all patients with no evidence of cerebrovascular side-effects in patients taking it. CONCLUSIONS: Psychotropic drugs were commonly used by older people in contact with mental health services. The doses of antipsychotics used in dementia and affective disorders were significantly lower than in schizophrenia. Risperidone was the most commonly used drug in all diagnostic groups including dementia. Despite a relatively large numbers of patients receiving risperidone in this naturalistic study, no serious side-effects were reported or identified. In this paper we focus our findings on antipsychotics in the light of recent advice from the Committee on Safety of Medicines (UK).

Critical Flicker Fusion Threshold in patients with Alzheimer's disease and vascular dementia.

BACKGROUND: Critical Flicker Fusion Threshold (CFFT) is a psychophysical threshold and in psychological terms is regarded as a measure of information processing capacity. The test has previously been shown to be a valid and reliable measure of CNS functioning in patients with Alzheimer's disease and may be a useful as a screening measure for the early detection of Alzheimer's disease (AD). METHODS: Consecutive referrals to the Wakefield Memory Clinic who met DSM-IV criteria for AD or vascular dementia (VaD) were invited to take part in the study. A range of neuropsychological tests and CFFT were administered to the two groups using standardised protocols and the ability of these various tests to distinguish between the two conditions was investigated. RESULTS: Forty-six patients were included in the study. Of the various tests, only the descending component of CFFT and word fluency were significantly different in the two groups. In addition, the descending threshold had a sensitivity of 83% and a specificity of 69%. CONCLUSION: CFFT could be useful as a screening instrument for early AD when combined with other measures and could facilitate the decision to commence antidementia treatment at an early stage. Further longitudinal work is needed to establish this.