The Journal of clinical psychiatry
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Agitated, aggressive behavior and psychosis are common manifestations of Alzheimer's disease that frequently lead to institutionalization. The usefulness of conventional neuroleptic treatment in this population is limited by narrow therapeutic windows because of limited efficacy and high sensitivity to side effects. More recently, investigational clinical trials have suggested potential utility for atypical antipsychotics such as risperidone, olanzapine, and quetiapine in treatment of behaviorally disturbed individuals and for the psychotic manifestations of dementia.
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Atypical neuroleptic agents are an excellent, safer, and more effective alternative to the widespread practice of maintenance adjunctive treatment with traditional neuroleptic agents in patients with bipolar disorder. Currently, a number of prospective studies are available with clozapine, risperidone, olanzapine, and quetiapine in the treatment of bipolar disorder. Most are short-term studies, although longer-term data are becoming available. ⋯ Nonetheless, they serve an important role as adjunctive treatments along with standard mood stabilizers in the rational polypharmacy of bipolar disorder. To date, differences in efficacy have not been established. However, differences in the side effect of weight gain may be even more relevant in bipolar disorder than in schizophrenia due to the need to use standard mood stabilizers that often potentiate such weight gain.
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Depressive symptoms and syndromal depression commonly occur in patients with schizophrenia. Schizophrenia is also associated with aggression directed at self and others. ⋯ These studies suggest that atypical antipsychotics may exert therapeutic effects on depression and hostility as well as psychosis and that clozapine and olanzapine may reduce suicidality in patients with schizophrenia. These therapeutic actions appear to represent additional advantages of atypical antipsychotics compared with standard agents.
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Review Case Reports
The emergency treatment of depression complicated by psychosis or agitation.
With the availability of newer, safer antidepressants in the past decade, initiation of definitive treatment for depression in the emergency setting has become an accepted practice. However, the use of newer antidepressants and atypical antipsychotics in depression complicated by psychosis or agitation has not yet been well studied. This article will review relevant data and make recommendations for the emergency management of psychotic and agitated depressive syndromes.