Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients.

OBJECTIVE Until recently, conventional antipsychotics were the standard pharmacotherapy for psychosis and behavioral disturbances associated with dementia. This double-blind, placebo-controlled study compared the acute efficacy of the selective serotonin reuptake inhibitor citalopram and the neuroleptic perphenazine with placebo for the treatment of psychosis and behavioral disturbances in nondepressed patients with dementia. METHOD Eighty-five hospitalized patients with at least one moderate to severe target symptom (aggression, agitation, hostility, suspiciousness, hallucinations, or delusions) were randomly assigned to receive either citalopram, perphenazine, or placebo under double-blind conditions for up to 17 days. RESULTS Patients treated with citalopram or perphenazine showed statistically significant improvement on several Neurobehavioral Rating Scale factor scores. Compared to those receiving placebo, only patients treated with citalopram showed significantly greater improvement in their total Neurobehavioral Rating Scale score as well as in the scores for the agitation/aggression and lability/tension factors. Side effect scores were similar among the three treatment groups. CONCLUSIONS Citalopram was found to be more efficacious than placebo in the short-term hospital treatment of psychotic symptoms and behavioral disturbances in nondepressed, demented patients.

[1]  B. Pollock,et al.  The 5-HTTPR*S/*L polymorphism and aggressive behavior in Alzheimer disease. , 2001, Archives of neurology.

[2]  D. Jeste,et al.  Psychosis of Alzheimer's disease and related dementias. Diagnostic criteria for a distinct syndrome. , 2000, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[3]  Jane S. Paulsen,et al.  Incidence of and risk factors for hallucinations and delusions in patients with probable AD , 2000, Neurology.

[4]  D. Jeste,et al.  Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone Study Group. , 1999, The Journal of clinical psychiatry.

[5]  B. Pollock,et al.  Behavioral Disturbances of Dementia , 1998, Journal of geriatric psychiatry and neurology.

[6]  D. Collier,et al.  5-HT2A and 5-HT2C receptor polymorphisms and psychopathology in late onset Alzheimer's disease. , 1998, Human molecular genetics.

[7]  B. Pollock,et al.  An open pilot study of citalopram for behavioral disturbances of dementia. Plasma levels and real-time observations. , 1997, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[8]  D. Sultzer,et al.  A double-blind comparison of trazodone and haloperidol for treatment of agitation in patients with dementia. , 1997, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[9]  R. Pies.  Must we now consider SRIs neuroleptics? , 1997, Journal of clinical psychopharmacology.

[10]  S. Tsai,et al.  Delusional jealousy in dementia. , 1997, The Journal of clinical psychiatry.

[11]  B. Pollock,et al.  METHODOLOGICAL ISSUES IN CHARACTERIZING TREATMENT RESPONSE IN DEMENTED PATIENTS WITH BEHAVIORAL DISTURBANCES , 1997, International journal of geriatric psychiatry.

[12]  S. Borson,et al.  Clinical features and pharmacologic treatment of behavioral symptoms of Alzheimer's disease , 1997, Neurology.

[13]  K. Kosaka,et al.  Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB) , 1996, Neurology.

[14]  Alison T. O'Brien,et al.  Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. , 1995, The Gerontologist.

[15]  G. Wilcock,et al.  Classification of psychotic symptoms in dementia sufferers , 1995, Acta psychiatrica Scandinavica.

[16]  B. Pollock,et al.  Antipsychotics in Older Patients , 1995 .

[17]  J. Hyttel.  Pharmacological characterization of selective serotonin reuptake inhibitors (SSRIs) , 1994, International clinical psychopharmacology.

[18]  J. Andersen,et al.  Fluvoxamine in the treatment of demented elderly patients: a double‐blind, placebo‐controlled study , 1992, Acta psychiatrica Scandinavica.

[19]  C. Gottfries,et al.  The Clinical Efficacy of Citalopram in Treatment of Emotional Disturbances in Dementia Disorders a Nordic Multicentre Study , 1990, British Journal of Psychiatry.

[20]  B. Lawlor.  Serotonin and Alzheimer's Disease , 1990 .

[21]  L. Schneider,et al.  A Metaanalysis of Controlled Trials of Neuroleptic Treatment in Dementia , 1990, Journal of the American Geriatrics Society.

[22]  U. Ahlfors,et al.  The UKU side effect rating scale: A new comprehensive rating scale for psychotropic drugs and a cross‐sectional study of side effects in neuroleptic‐treated patients , 1987, Acta psychiatrica Scandinavica. Supplementum.

[23]  H. Levin,et al.  The neurobehavioural rating scale: assessment of the behavioural sequelae of head injury by the clinician. , 1987, Journal of neurology, neurosurgery, and psychiatry.

[24]  P. Jansson,et al.  A double‐blind comparison of alaproclate and placebo in the treatment of patients with senile dementia , 1985, Acta psychiatrica Scandinavica.

[25]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[26]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[27]  B. Pollock,et al.  Prospective cytochrome P450 phenotyping for neuroleptic treatment in dementia. , 1995, Psychopharmacology bulletin.