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Letters   |    
Citalopram in Agitated and Delusional Demented Patients Who Failed Treatment With Antipsychotic Agents
Nabil Kotbi, M.D.; Arun Singh, D.O.; Jerard Kneifati-Hayek, B.A.; Anna Odom, Ph.D.; George Alexopoulos, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E62. doi:10.1176/appi.neuropsych.13060122
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Dr. Alexopoulos has received grant support from Forest; he has served as a consultant to Forest, Hoffman-La Roche, Janssen, Lilly, Lundbeck, Pfizer, and Otsuka; and he currently serves or has served on the speakers' bureau of AstraZeneca, Avanir, Forest, Merck, Novartis, Sunovion, and Takeda-Lundbeck. All other authors report no financial relationships with commercial interests.

Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY

Send correspondence to Dr. Odom; e-mail: ano9021@med.cornell.edu

Copyright © 2014 by the American Psychiatric Association

Extract

To the Editor: Agitation is a common, difficult to treat complication of dementing disorders. Optimal management of agitation consists of treatment of precipitants of agitation, including undiagnosed medical problems, pain, drug toxicity, environmental triggers, poor sleep, delirium, and depression.1 When precipitants of agitation are either absent or successfully treated, pharmacological treatment may target the syndrome of agitation. Antipsychotic agents are recommended as the first line treatment for this purpose. However, antipsychotic drugs have modest efficacy2 and entail safety concerns including orthostasis, drowsiness, extrapyramidal syndromes, incoordination, metabolic syndrome, prolonged QTc in EKG, and cerebrovascular events.3

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References

Salzman  C;  Jeste  DV;  Meyer  RE  et al:  Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy.  J Clin Psychiatry 2008; 69:889–898
[CrossRef] | [PubMed]
 
Sink  KM;  Holden  KF;  Yaffe  K:  Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence.  JAMA 2005; 293:596–608
[CrossRef] | [PubMed]
 
Steinberg  M;  Lyketsos  CG:  Atypical antipsychotic use in patients with dementia: managing safety concerns.  Am J Psychiatry 2012; 169:900–906
[CrossRef] | [PubMed]
 
Pollock  BG;  Mulsant  BH;  Rosen  J  et al:  Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients.  Am J Psychiatry 2002; 159:460–465
[CrossRef] | [PubMed]
 
Pollock  BG;  Mulsant  BH;  Rosen  J  et al:  A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia.  Am J Geriatr Psychiatry 2007; 15:942–952
[CrossRef] | [PubMed]
 
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