Evidence map›Paper›PMID 27855483›Full record

ArticleThe American journal of psychiatry2017

Prediction of Relapse After Discontinuation of Antipsychotic Treatment in Alzheimer's Disease: The Role of Hallucinations.

Anjali N Patel, Seonjoo Lee, Howard F Andrews, Gregory H Pelton, Susan K Schultz, David L Sultzer, Jacobo Mintzer, Danilo de la Pena, Sanjay Gupta, Sylvia Colon and 3 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of psychiatry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
3.5field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 22 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 1 institution in 1 country.

Anjali N PatelFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Seonjoo LeeFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Howard F AndrewsFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Gregory H PeltonFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Susan K SchultzFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
David L SultzerFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Jacobo MintzerFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Danilo de la PenaFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Sanjay GuptaFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Sylvia ColonFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Corbett SchimmingFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Bruce LevinFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
D P DevanandFrom the Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York; the Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University, and the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York; the Division of Translational Research, Department of Neuroscience, Medical University of South Carolina, and the Ralph H. Johnson VA Medical Center, Charleston; the Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston; the Research Center for Clinical Studies, Norwalk, Conn.; the Department of Psychiatry, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo; the Department of Psychiatry, VA Medical Center, Tuscaloosa, Ala.; and the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York.
Columbia University · US

Funding

VESICULAR LOCALIZATION AND FUNCTION OF PRESENILIN 1 FRAGMENTP50AG005138 · NIA · MOUNT SINAI SCHOOL OF MEDICINE OF NYU · PI SCHIMMING, CORBETT · 1985 to 2019
$37.9M
QUESTIONABLE DEMENTIA: COURSE AND PREDICTORS OF OUTCOMER01AG017761 · NIA · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI DEVANAND, DAVANGERE P · 2000 to 2012
$7.3M
Antipsychotic Discontinuation in Alzheimer s DiseaseR01AG021488 · NIA · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · PI DEVANAND, DAVANGERE P · 2003 to 2008
$4.6M
Pilot Combination Treatment Trial of Mild Cognitive Impairment with DepressionR01AG040093 · NIA · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · PI DEVANAND, DAVANGERE P · 2011 to 2013
$2.0M
NIA NIH HHS P50 AG005138NIA NIH HHS R01 AG017761NIA NIH HHS R01 AG021488NIA NIH HHS R01 AG040093
6 · The paper itself

Abstract

objectiveIn Alzheimer's disease, antipsychotic medications are often used for a period, with relief of symptoms, and then discontinued, after which relapse may occur. The authors sought to determine which neuropsychiatric symptoms predict relapse.

methodIn the Antipsychotic Discontinuation in Alzheimer's Disease trial, 180 patients with Alzheimer's disease and symptoms of agitation or psychosis were treated with risperidone for 16 weeks, after which patients who responded (N=110) were randomly assigned to continue risperidone for 32 weeks, to continue risperidone for 16 weeks followed by switch to placebo for 16 weeks, or to receive placebo for 32 weeks. As reported previously, discontinuation of risperidone was associated with a two- to fourfold increased risk of relapse over 16-32 weeks. In planned post hoc analyses, the authors examined associations between the 12 symptom domains in the Neuropsychiatric Inventory (NPI) and relapse in the first 16-week phase after randomization.

resultsCompared with patients with mild hallucinations or no hallucinations, patients with severe hallucinations as a presenting symptom at baseline had a higher likelihood of relapse (hazard ratio=2.96, 95% CI=1.52, 5.76). This effect was present for the subgroup with auditory hallucinations, but not the subgroup with visual hallucinations. Among patients with baseline hallucinations, 13 of 17 (76.5%) who discontinued risperidone relapsed, compared with 10 of 26 (38.5%) who continued risperidone (p<0.02). This group difference remained significant for severe (77.8%) compared with mild (36%) hallucinations. NPI domain scores after the initial open-treatment phase were not associated with relapse.

conclusionsPatients with severe baseline hallucinations were more likely to relapse after randomization, and the presence of baseline hallucinations was associated with a higher risk of relapse after discontinuation of risperidone compared with continued risperidone treatment. For patients with hallucinations, particularly auditory hallucinations, antipsychotic discontinuation should be approached cautiously because of high relapse risk.

Indexed as

AgedAlzheimer DiseaseAntipsychotic AgentsFemaleHallucinationsHumansIntention to Treat AnalysisKaplan-Meier EstimateLikelihood FunctionsMaleNeuropsychological TestsProportional Hazards ModelsRecurrenceRisperidoneSubstance Withdrawal SyndromeAntipsychotic AgentsRisperidoneAntipsychoticsBehavioral NeurologyDementia-Alzheimer-s Disease

Identifiers

PMID27855483
PMCPMC5378647
OpenAlexW2553203127

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.