***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The objectives of this study were to evaluate the efficacy , safety , and tolerability of quetiapine for treating psychosis in patients with probable/possible Alzheimer disease and assess its impact on other psychopathology and social and daily functioning . METHOD The authors conducted a multicenter , double-blind , placebo-controlled , r and omized trial of flexibly dosed quetiapine and haloperidol . Primary outcomes were change in total Brief Psychiatric Rating Scale ( BPRS ) and Clinical Global Impressions-Severity of Illness ( CGI-S ) scores at week 10 . Secondary outcomes included BPRS factors , Neuropsychiatric Inventory ( NPI ) , Multidimensional Observation Scale for Elderly Subjects ( MOSES ) , and Physical Self-Maintenance Scale ( PSMS ) . RESULTS Two hundred eighty-four participants ( mean age : 83.2 years ) were r and omized ; 63.4 % completed ; and mean Mini-Mental State Examination score was 12.8 . Median of the mean daily dose was 96.9 mg for quetiapine and 1.9 mg for haloperidol . No differential benefit was seen on any psychosis measure . BPRS agitation factor scores improved with quetiapine versus placebo and not quetiapine versus haloperidol .  BPRS anergia scores worsened with haloperidol versus quetiapine but not quetiapine versus placebo . No NPI factors showed change , including the agitation factor . MOSES Withdrawal Subscale and PSMS total scores worsened with haloperidol versus quetiapine .  Somnolence occurred in 25.3 % , 36.2 % , and 4.1 % of the quetiapine , haloperidol , and placebo groups , respectively ; parkinsonism was most prevalent in the haloperidol group ; other safety and tolerability measures differed little among groups . CONCLUSION All treatment groups showed improvement in measures of psychosis without significant differences between them when planned comparisons were performed . Participants treated with quetiapine or haloperidol showed inconsistent evidence of improvement in agitation . Tolerability was better with quetiapine compared with haloperidol BACKGROUND Despite modest efficacy , unpredictable individual utility , and a high rate of adverse effects , behavioural and psychological symptoms of dementia ( BPSD ) are common determinants for antipsychotic drug therapy in nursing home patients . AIMS To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia . METHODS Fifty-five patients ( 43 women ; mean age 84.1 ) taking haloperidol , risperidone , or olanzapine for BPSD were r and omly assigned to cessation ( intervention group , n=27 ) or continued treatment with antipsychotic drugs ( reference group , n=28 ) for 4 consecutive weeks . The Neuropsychiatric Inventory ( NPI ) Question naire was used to examine changes in behavioural and psychological symptoms . RESULTS By study completion , 23 of the 27 intervention group patients were still off antipsychotics . Symptom scores ( NPI ) remained stable or even improved in 42 patients ( intervention group , 18 out of 27 ; reference group , 24 out of 28 ; p=0.18 ) . As compared to patients with stable or improved symptom scores , patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline ( p=0.42 ) . CONCLUSION A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD , do well without this treatment . St and ardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals OBJECTIVE To compare citalopram and risperidone for the treatment of psychotic symptoms and agitation associated with dementia , with a priori hypotheses that risperidone would be more efficacious for psychosis and citalopram for agitation . METHODS A 12-week r and omized , controlled trial in nondepressed patients with dementia hospitalized because of behavioral symptoms ( N = 103 ) was conducted at the University of Pittsburgh Medical Center . Participants were consecutively recruited on an inpatient unit if they had at least one moderate to severe target symptom ( aggression , agitation , hostility , suspiciousness , hallucinations , or delusions ) . Once they improved sufficiently , they were discharged to nursing homes , personal care homes , or residential homes for continued treatment . Planned pre-post and mixed model analyses of the main outcome measures of Neurobehavioral Rating Scale and Side Effect Rating Scale at baseline and at weekly/biweekly intervals were conducted . RESULTS Completion rates did not differ for citalopram and risperidone ( overall completion rate : 44 % ) . Agitation symptoms ( aggression , agitation , or hostility ) and psychotic symptoms ( suspiciousness , hallucinations , or delusions ) decreased in both treatment groups but the improvement did not differ significantly between the two groups . There was a significant increase in side effect burden with risperidone but not with citalopram such that the two groups differed significantly . CONCLUSION No statistical difference was found in the efficacy of citalopram and risperidone for the treatment of either agitation or psychotic symptoms in patients with dementia . These findings need to be replicated before citalopram or other serotonergic antidepressants can be recommended as alternatives to antipsychotics for the treatment of agitation or psychotic symptoms associated with dementia BACKGROUND Second-generation ( atypical ) antipsychotic drugs are widely used to treat psychosis , aggression , and agitation in patients with Alzheimer 's disease , but their benefits are uncertain and concerns about safety have emerged . We assessed the effectiveness of atypical antipsychotic drugs in out patients with Alzheimer 's disease . METHODS In this 42-site , double-blind , placebo-controlled trial , 421 out patients with Alzheimer 's disease and psychosis , aggression , or agitation were r and omly assigned to receive olanzapine ( mean dose , 5.5 mg per day ) , quetiapine ( mean dose , 56.5 mg per day ) , risperidone ( mean dose , 1.0 mg per day ) , or placebo . Doses were adjusted as needed , and patients were followed for up to 36 weeks . The main outcomes were the time from initial treatment to the discontinuation of treatment for any reason and the number of patients with at least minimal improvement on the Clinical Global Impression of Change ( CGIC ) scale at 12 weeks . RESULTS There were no significant differences among treatments with regard to the time to the discontinuation of treatment for any reason : olanzapine ( median , 8.1 weeks ) , quetiapine ( median , 5.3 weeks ) , risperidone ( median , 7.4 weeks ) , and placebo ( median , 8.0 weeks ) ( P=0.52 ) . The median time to the discontinuation of treatment due to a lack of efficacy favored olanzapine ( 22.1 weeks ) and risperidone ( 26.7 weeks ) as compared with quetiapine ( 9.1 weeks ) and placebo ( 9.0 weeks ) ( P=0.002 ) . The time to the discontinuation of treatment due to adverse events or intolerability favored placebo . Overall , 24 % of patients who received olanzapine , 16 % of patients who received quetiapine , 18 % of patients who received risperidone , and 5 % of patients who received placebo discontinued their assigned treatment owing to intolerability ( P=0.009 ) . No significant differences were noted among the groups with regard to improvement on the CGIC scale . Improvement was observed in 32 % of patients assigned to olanzapine , 26 % of patients assigned to quetiapine , 29 % of patients assigned to risperidone , and 21 % of patients assigned to placebo ( P=0.22 ) . CONCLUSIONS Adverse effects offset advantages in the efficacy of atypical antipsychotic drugs for the treatment of psychosis , aggression , or agitation in patients with Alzheimer 's disease . ( Clinical Trials.gov number , NCT00015548 [ Clinical Trials.gov ] . ) CONTEXT Agitation and psychosis are common in Alzheimer disease and cause considerable morbidity . We attempted to delay or to prevent agitation and psychosis with the use of divalproex sodium ( valproate ) . OBJECTIVE To determine whether treatment with valproate could delay or prevent emergence of agitation or psychosis . DESIGN , SETTING , AND PATIENTS A multicenter , r and omized , double-blind , placebo-controlled trial of flexible-dose valproate in 313 ( of 513 screened ) individuals with moderate Alzheimer disease who had not yet experienced agitation or psychosis . The study was conducted from November 1 , 2005 , through March 31 , 2009 , at 46 sites in the United States . INTERVENTION Participants were r and omly assigned to valproate treatment at a target dose of 10 to 12 mg per kilogram of body weight per day or identical-appearing placebo for 24 months followed by a 2-month period of single-blind placebo treatment . MAIN OUTCOME MEASURE Time to emergence of clinical ly significant agitation or psychosis . RESULTS A total of 122 participants ( 59 receiving valproate and 63 receiving placebo ) completed 24 months of treatment while taking study medication ; 42 ( 27 receiving valproate and 15 receiving placebo )  reached 24 months having discontinued study medication ; 150 reached month 26 . There was no difference between groups in time to emergence of agitation or psychosis ( Cox proportional hazard ratio , 0.96 ; P = .88 ) . There was no difference between groups in change on any secondary outcome . The valproate group had higher rates of somnolence , gait disturbance , tremor , diarrhea , and weakness .  Eighty-eight participants underwent magnetic resonance imaging scans at baseline and 12 months ; the valproate group showed greater loss in hippocampal and whole-brain volume , accompanied by greater ventricular expansion ( P < .001 ) . CONCLUSION Valproate treatment did not delay emergence of agitation or psychosis or slow cognitive or functional decline in patients with moderate Alzheimer disease and was associated with significant toxic effects OBJECTIVES To explore the effect on sleep/wake activity and on behavioral and psychological symptoms of the withdrawal of antipsychotic medications from nursing home ( NH ) patients with dementia . DESIGN R and omized , placebo-controlled , double-blind trial . SETTING NHs in Bergen , Norway . PARTICIPANTS Thirty patients ( mean age 83.5 ) taking haloperidol , risperidone , or olanzapine for nonpsychotic symptoms . INTERVENTION Study participants were r and omly assigned to withdrawal ( intervention group ) or continued treatment with antipsychotic medications ( reference group ) for 4 consecutive weeks . MEASUREMENTS Behavioral rating using the Neuropsychiatric Inventory Question naire ( NPI-Q ) and actigraphy . RESULTS After antipsychotic withdrawal , behavioral scores remained stable or improved in 11 of 15 patients , whereas four had worsening scores . Actigraphy revealed decreased sleep efficiency after drug discontinuation and increased 24-hour and night activity in both groups . Actigraphy records of nighttime and daytime activity indicated sleep problems and restlessness , in terms of the NPI-Q. One patient was restarted on antipsychotics . CONCLUSION Antipsychotic drug withdrawal affected activity and sleep efficiency over the short term . Increases in total activity and impaired sleep quality after drug discontinuation should be monitored , because the long-term effect of these changes is not known . The NPI-Q and actigraphy are feasible tools that disclose relevant changes occurring during antipsychotic withdrawal in NH patients with dementia . Their use in clinical practice should be substantiated by larger studies Context Recent reports suggest that antipsychotics are associated with increased risk for death in patients with dementia . Contribution This large , population -based study from Canada assessed the risk for death after dispensation of antipsychotics in older adults with dementia . New use of antipsychotics compared with nonuse was associated with increased risk for death at 30 days . Conventional agents were associated with higher risks than were atypical agents . Caution Sensitivity analyses showed that unmeasured confounders might diminish or erase observed associations . Implication Both conventional and atypical antipsychotics may be associated with an increased risk for death in elderly persons with dementia . The Editors Various challenging behavioral and psychological symptoms commonly develop in older adults with dementia and predispose them and their caregivers to poor outcomes ( 1 ) . Nonpharmacologic strategies are recommended as first-line management for these symptoms ( 2 ) , but they may be difficult to implement in clinical practice ( 3 ) . For many reasons , antipsychotic medications are routinely prescribed in this setting ( 4 , 5 ) . Conventional antipsychotics , such as haloperidol , have been available since the 1950s . Meta-analyses of clinical trials evaluating conventional antipsychotics to treat agitation in dementia show that these agents have modest efficacy and important adverse effects compared with placebo ( 6 , 7 ) . In the past decade , use of newer atypical antipsychotics has been rapidly increasing in clinical practice because these agents were thought to produce fewer adverse effects than conventional agents ( 2 ) . A Canadian study found that the prevalence of antipsychotic use in older adults increased from 2.2 % in 1993 to 3 
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Some studies reported higher rates of trial withdrawals , adverse events , and mortality associated with medications .
We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC population s. However , the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population