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Biomedical subjects

Philip E Lee

Publications and source records attributed to Philip E Lee.

8 recordsLinked to original sources
PubMed2005

Atypical antipsychotics and parkinsonism.

BACKGROUND: Atypical antipsychotic agents are thought to be less likely than older typical agents to produce parkinsonism. This has not been well documented. We compared the risk of development of incident parkinsonism among older adults dispensed atypical relative to typical antipsychotics. METHODS: Retrospective cohort study of all adults 66 years and older in Ontario. We used Cox proportional hazards models to study the association between the type, potency, and dose of antipsychotic dispensed and the development of parkinsonism during 1 year of follow-up. RESULTS: All 25,769 older adults prescribed antipsychotics were observed for 11,573 person-years, and 449 events of parkinsonism were identified. Relative to individuals dispensed an atypical antipsychotic, those dispensed a typical agent were 30% more likely (adjusted hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.04-1.58) and those exposed to neither agent were 60% less likely (HR, 0.40; 95% CI, 0.29-0.43) to experience development of parkinsonism. Furthermore, those dispensed lower-potency typical agents were no different (HR, 0.75; 95% CI, 0.48-1.15), and those dispensed higher-potency typical antipsychotics were at close to a 50% greater risk (HR, 1.44; 95% CI, 1.13-1.84) of development of parkinsonism relative to atypical antipsychotics. Relative to those dispensed a high-dose atypical antipsychotic, those dispensed a typical antipsychotic were at similar risk for parkinsonism (Wald chi(2) = 0.14, P = .7). CONCLUSIONS: The risk of development of parkinsonism associated with the use of high-dose atypical antipsychotics was similar to that associated with the use of typical antipsychotics. Caution should be used when prescribing atypical antipsychotic therapy at high doses.

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PubMed2005

A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs.

BACKGROUND: The prescribing cascade model involves the misinterpretation of an adverse reaction to 1 drug and the subsequent, potentially inappropriate prescription of a second drug. We present a new example of the prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs used to manage urinary incontinence. METHODS: A population-based retrospective cohort study was carried out in Ontario, Canada. Participants included 44,884 older adults with dementia (20,491 were dispensed a cholinesterase inhibitor and 24,393 were not), enrolled between June 1, 1999, and March 31, 2002. Subjects were observed until they received an anticholinergic drug, stopped the cholinesterase inhibitor treatment, died, or the study period ended (March 31, 2003). The main outcome measure was receipt of an anticholinergic drug to manage urinary incontinence. RESULTS: After adjusting for potential confounding factors, we observed that older adults with dementia who were dispensed cholinesterase inhibitors had an increased risk of subsequently receiving an anticholinergic drug (4.5% vs 3.1%; P<.001; adjusted hazard ratio, 1.55; 95% confidence interval, 1.39-1.72), relative to those not receiving cholinesterase inhibitors. This finding was consistent in a series of subgroup analyses. CONCLUSIONS: Use of cholinesterase inhibitors is associated with an increased risk of receiving an anticholinergic drug to manage urinary incontinence. The use of an anticholinergic drug in this setting may represent a clinically important prescribing cascade. Clinicians should consider the possible contributing role of cholinesterase inhibitors in new-onset or worsening urinary incontinence and the potential risk of coprescribing cholinesterase inhibitors and anticholinergic drugs to patients with dementia.

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PubMed2005

Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study.

OBJECTIVE: To compare the incidence of admissions to hospital for stroke among older adults with dementia receiving atypical or typical antipsychotics. DESIGN: Population based retrospective cohort study. SETTING: Ontario, Canada. Patients 32,710 older adults (< or = 65 years) with dementia (17,845 dispensed an atypical antipsychotic and 14,865 dispensed a typical antipsychotic). MAIN OUTCOME MEASURES: Admission to hospital with the most responsible diagnosis (single most important condition responsible for the patient's admission) of ischaemic stroke. Observation of patients until they were either admitted to hospital with ischaemic stroke, stopped taking antipsychotics, died, or the study ended. RESULTS: After adjustment for potential confounders, participants receiving atypical antipsychotics showed no significant increase in risk of ischaemic stroke compared with those receiving typical antipsychotics (adjusted hazard ratio 1.01, 95% confidence interval 0.81 to 1.26). This finding was consistent in a series of subgroup analyses, including ones of individual atypical antipsychotic drugs (risperidone, olanzapine, and quetiapine) and selected subpopulations of the main cohorts. CONCLUSION: Older adults with dementia who take atypical antipsychotics have a similar risk of ischaemic stroke to those taking typical antipsychotics.

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PubMed2005

Antipsychotic medications and drug-induced movement disorders other than parkinsonism: a population-based cohort study in older adults.

OBJECTIVES: To study the relationship between initiating therapy with an antipsychotic medication and a subsequent new diagnosis of a drug-induced movement disorder other than parkinsonism in older adults with dementia. DESIGN: Retrospective, population-based cohort study. SETTING: Ontario, Canada. PARTICIPANTS: Ontario residents aged 66 and older with a diagnosis of dementia newly started on treatment with typical or atypical antipsychotic therapy. MEASUREMENT: Estimated relative risk of developing a drug-induced movement other than parkinsonism in the 1-year follow-up period after starting therapy with an antipsychotic medication. RESULTS: From April 1, 1997, to March 31, 2001, 21, 835 older adults with dementia who were newly started on antipsychotic medications were identified. Nine thousand seven hundred ninety subjects were started on atypical antipsychotics and 12,045 subjects started on typical antipsychotics. Demographic characteristics were similar between the groups. There were 5.24 cases of tardive dyskinesia (TD) or other drug-induced movement disorder per 100 person-years on therapy with a typical antipsychotic and 5.19 cases per 100 person-years on therapy with an atypical antipsychotic. The risk of developing drug-induced movement disorder while being treated with an atypical agent was not statistically different from that with a typical antipsychotic (relative risk=0.99, 95% confidence interval=0.86-1.15; P<.93). CONCLUSION: Older adults with dementia who are treated with typical or atypical antipsychotic therapy are at risk for developing TD and other drug-induced movement disorders.

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PubMed2005

New thyroxine treatment in older adults beginning lithium therapy: implications for clinical practice.

OBJECTIVE: The authors sought to determine the incidence of lithium-induced hypothyroidism in a population-based cohort of older adults beginning lithium therapy and thereby to inform clinical guidelines on the frequency of monitoring necessary in this group. METHODS: The authors conducted a population-based observational cohort study using four administrative databases that contained information on over 1.3 million older adults in Ontario who receive universal healthcare coverage in terms of physician services, drugs, and hospitalizations. Over an 18-month period, they studied adults age>or=65 who were newly prescribed lithium or valproate, monitoring subjects for initiation of T4 therapy (as a proxy for hypothyroidism) while they continued their lithium use. RESULTS: The authors identified 1,705 new users of lithium and 2,406 new users of valproate with similar baseline characteristics. Lithium users were significantly more likely to be treated with T4 than were valproate users. The rate of T4 treatment per 100 person-years was 5.65 in the lithium group and 2.70 in the valproate group. CONCLUSION: T4 treatment was initiated in almost 6% of lithium-treated patients, suggesting the possibility that hypothyroidism developed twice as frequently among these patients as would be expected among a mixed-age population. Increased vigilance and continued monitoring of thyroid functioning for at least 2 years is necessary in older adults beginning lithium therapy.

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PubMed2004

Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review.

OBJECTIVE: To review the role of oral atypical antipsychotic drugs in the management of the behavioural and psychological symptoms of dementia (BPSD). DATA SOURCES: Medline, Embase, and the Cochrane Library. Reference lists were reviewed and experts were contacted to identify additional trials. STUDY SELECTION: Double blind randomised controlled trials that evaluated the four oral atypical antipsychotic therapies for BPSD. REVIEW METHODS: Two reviewers assessed trial validity independently. DATA EXTRACTION: Demographics of patients, study duration, dose of antipsychotic, primary end points, adverse events. RESULTS: 77 abstracts were reviewed. Five randomised trials (1570 patients) evaluating risperidone and olanzapine were identified. The quality of trials was generally good. Most participants were in an institution (> 96%), elderly (weighted mean 82.3 years), and had Alzheimer's disease (76.3%). Trials lasted 6-12 weeks. Treatment with atypical antipsychotic drugs was superior to placebo for the primary end point in three of the five trials. Two trials comparing risperidone with haloperidol did not find any differences in the primary measures of efficacy. Adverse events were common and included extrapyramidal symptoms, somnolence, and abnormal gait. CONCLUSIONS: Although atypical antipsychotic drugs are being used with increasing frequency, few randomised trials have evaluated their use for BPSD. Limited evidence supports the perception of improved efficacy and adverse event profiles compared with typical antipsychotic drugs.

Administration, Oral↗
PubMed2004

Teaching physicians geriatric principles: a randomized control trial on academic detailing plus printed materials versus printed materials only.

BACKGROUND: We compared the effectiveness of academic detailing with printed materials, versus printed materials only, on promoting geriatric knowledge among physicians. METHODS: 31 physicians were randomly assigned to receive academic detailing plus printed materials (group 1 intervention, n = 16), or printed materials alone (group 2 control, n = 15), on 5 geriatric topics identified from a needs assessment survey. Two participants withdrew from group 2, leaving 13 in the control group. Both groups received printed educational materials between baseline and time 1, and at time 2. Only group 1 received an additional 15-minute, one-on-one education session with a geriatrician at time 2. The primary endpoint was knowledge retention, measured by the numeric score of a 5-item questionnaire (range 0 to 5), comprised of items from the Geriatrics Knowledge Test. Knowledge retention was measured at baseline, 1 week (time 1), and on average 29 weeks later (time 2). RESULTS: Most participants were postgraduate trainees. The mean knowledge score in all participants decreased from 3.6 +/- 1.2 at baseline to 3.1 +/- 1.2 at time 1 (p =.006). 19 participants (9 in group 1 and 10 in group 2) completed the knowledge questionnaire at time 2. At baseline, group 1 scored lower than group 2 (3.4 +/- 1.3 versus 3.8 +/- 1.1, p =.39); whereas at time 2, group 1 scored significantly higher than group 2 (4.7 +/- 0.7 versus 3.9 +/- 0.7, p =.034). Academic detailing plus printed materials produced higher mean score change from baseline (1.1 +/- 1.3) than printed materials alone (0.0 +/- 1.1, p =.053). CONCLUSIONS: Academic detailing plus printed materials improved knowledge retention among physicians, whereas printed materials only did not.

Education, Medical, Continuing↗