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Elderly people with dementia and agitation often cause their medical attendants to reach for the prescription pad or the medication chart and try out some antipsychotic medication, usually one of the “atypicals.” We justify such prescriptions as likely to lessen distress of the patient and make life easier for the carers, but recent studies have proved that in most cases it is both ineffective and dangerous. According to a retrospective cohort study from Canada (Arch Intern Med 2008;168:1090–6), adverse events are increased more than threefold in the first month after an atypical antipsychotic has been prescribed to a demented patient in a nursing home. A Dutch case-control study finds that demented patients currently prescribed an atypical antipsychotic are at increased risk of pneumonia (odds ratio [OR] 1.6; J Am Geriatr Soc 2008;56:661–6). The US Food and Drug Administration warned us about such risks in 2005 after carrying out its own meta-analysis of 17 placebo controlled trials of atypical antipsychotics in this patient group, …
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