Introduction: We evaluated use of ziprasidone in fragile, elderly patients with dementia-related behavioral problems (irritability, agitation, combativeness, depression, mood lability).
Design: The study was based on a retrospective case review.
Methods: We conducted a chart review of 14 patients admitted to an inpatient psychiatric facility with Axis I diagnoses of mood and behavior disturbances secondary to multi-infarct dementia, Alzheimer’s disease, schizoaffective disorder, bipolar disorder, and major depression. All patients had >1 major medical illness, including in some cases atrial fibrillation or congestive heart failure.
Results: Most patients had received antipsychotic therapy before hospital admission. Treatment with various psychotropic agents (haloperidol, olanzapine, risperidone, paroxetine, fluvoxamine, lamotrigine, oxcarbazepine, divalproex sodium, topiramate), often given concomitantly, failed to resolve symptoms or caused intolerable side effects. Ziprasidone, usually in combination with other psychotropics, minimized behavioral symptoms, agitation, depression, and cognitive decline sufficiently to enable discharge. The most common side effect was sedation, which generally responded to 20-mg dose reductions and tended not to recur with reinstitution of ziprasidone. There were no significant QTc findings or recorded postural hypotension or syncope.
Conclusion: In summary, ziprasidone proved safe and effective in 14 elderly patients with dementia-related behavioral disturbances and depression-related psychosis when other atypical antipsychotics failed to improve symptoms or caused intolerable side effects.
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