Effect of Antipsychotic Withdrawal on Behavior and Sleep/Wake Activity in Nursing Home Residents with Dementia: A Randomized, Placebo-Controlled, Double-Blinded Study The Bergen District Nursing Home Study

Authors

  • Sabine Ruths MD,

    1. From the Sections for *Geriatric MedicineGeneral Practice, Department of Public Health and Primary Health Care, and Department of Psychosocial Science, University of Bergen, Bergen, Norway§Section for General Practice/Family Medicine, Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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  • Jørund Straand MD, PhD,

    1. From the Sections for *Geriatric MedicineGeneral Practice, Department of Public Health and Primary Health Care, and Department of Psychosocial Science, University of Bergen, Bergen, Norway§Section for General Practice/Family Medicine, Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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  • Harald A. Nygaard MD, PhD,

    1. From the Sections for *Geriatric MedicineGeneral Practice, Department of Public Health and Primary Health Care, and Department of Psychosocial Science, University of Bergen, Bergen, Norway§Section for General Practice/Family Medicine, Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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  • Bjørn Bjorvatn MD, PhD,

    1. From the Sections for *Geriatric MedicineGeneral Practice, Department of Public Health and Primary Health Care, and Department of Psychosocial Science, University of Bergen, Bergen, Norway§Section for General Practice/Family Medicine, Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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  • Ståle Pallesen PhD

    1. From the Sections for *Geriatric MedicineGeneral Practice, Department of Public Health and Primary Health Care, and Department of Psychosocial Science, University of Bergen, Bergen, Norway§Section for General Practice/Family Medicine, Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway.
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Address correspondence to Sabine Ruths, MD, Section for Geriatric Medicine, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway. E-mail: sabine.ruths@isf.uib.no

Abstract

Objectives: To explore the effect on sleep/wake activity and on behavioral and psychological symptoms of the withdrawal of antipsychotic medications from nursing home (NH) patients with dementia.

Design: Randomized, placebo-controlled, double-blind trial.

Setting: NHs in Bergen, Norway.

Participants: Thirty patients (mean age 83.5) taking haloperidol, risperidone, or olanzapine for nonpsychotic symptoms.

Intervention: Study participants were randomly assigned to withdrawal (intervention group) or continued treatment with antipsychotic medications (reference group) for 4 consecutive weeks.

Measurements: Behavioral rating using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and actigraphy.

Results: After antipsychotic withdrawal, behavioral scores remained stable or improved in 11 of 15 patients, whereas four had worsening scores. Actigraphy revealed decreased sleep efficiency after drug discontinuation and increased 24-hour and night activity in both groups. Actigraphy records of nighttime and daytime activity indicated sleep problems and restlessness, in terms of the NPI-Q. One patient was restarted on antipsychotics.

Conclusion: Antipsychotic drug withdrawal affected activity and sleep efficiency over the short term. Increases in total activity and impaired sleep quality after drug discontinuation should be monitored, because the long-term effect of these changes is not known. The NPI-Q and actigraphy are feasible tools that disclose relevant changes occurring during antipsychotic withdrawal in NH patients with dementia. Their use in clinical practice should be substantiated by larger studies.

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