Effects of Antipsychotic Withdrawal in Elderly Nursing Home Residents

Objective To study the effects of antipsychotic withdrawal in elderly nursing home residents. Design Longitudinal prospective study. Setting: 12 community nursing homes that participated in a randomized controlled trial of an educational program designed to reduce antipsychotic use. Subjects 271 residents receiving antipsychotics at baseline and remaining in the home for approximately 6 months thereafter. These were placed into two groups: those with continued use of antipsychotics at follow‐up ( n = 207) and those with drug discontinued ( n = 64). Measurements Change between baseline and follow‐up for several standard measurements. These included behavior problems, as reported by both regular care providers (Nursing Home Behavior Problem Scale) or a blinded study rater (items from the Brief Psychiatric Rating Scale), observer‐rated psychiatric symptoms (subset of the Brief Psychiatric Rating Scale), and other standard tests of function (Activities of Daily Living, Mini‐Mental State Examination, Geriatric Depression Scale, and Abnormal Involuntary Movements Scale). Results The frequency of behavior problems did not increase in residents with antipsychotics discontinued. For these residents, observer‐rated psychiatric symptoms decreased by 21% ( P = 0.003), which resulted from a 27% decrease in adverse affective symptoms ( P = 0.0002). Residents with drug discontinued had no deterioration in any of the measures of function. Conclusion In this sample, nursing home residents whose antipsychotics were discontinued had significantly improved affect and no discernable adverse effects.