These preliminary results are sellekchem encouraging but, to our knowledge, no placebo-controlled examination of aripiprazole for TRLLD has been carried out. Safety issues with atypicals in older adults Atypicals have come under scrutiny

due to the metabolic disturbances they may cause and safety issues uncovered in older patients with dementia. Weight, gain and related metabolic disturbances such as glucose intolerance and dyslipidemia occur more frequently in psychiatric patients than the general population, with the Inhibitors,research,lifescience,medical totality of risk related not only to medication effects but. to under lying characteristics of the patient, population (eg, baseline overweight, and obesity, high fat/high caloric diet, poor medical care).95 The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) confirmed other reports demonstrating risks for metabolic disturbances with atypicals, although that study did not. examine aripiprazole. Among the atypicals, Inhibitors,research,lifescience,medical risk of weight gain, dyslipidemia, and diabetes is highest with clozapine and olanzapine; more modest, weight, gain is generally observed with quetiapine and risperidone, along with lower insulin resistance risk, variably lower dyslipidemia risk,

and largely Inhibitors,research,lifescience,medical negative if somewhat discrepant results concerning diabetes risk. The lowest, risk of weight gain, as well as little or no risk for dyslipidemia or diabetes, is observed with aripiprazole and ziprasidone.95-97 These metabolic risks have not been consistently reported in the elderly, where some studies indicate little or no weight gain, even on higher-risk selleck chemical Rucaparib agents (eg Inhibitors,research,lifescience,medical refs 98-100). However, there are limited data in elderly samples, and available reports that include a placebo group Inhibitors,research,lifescience,medical often find weight loss, consistent

with progressive reductions in lean muscle mass. Thus, in elderly persons, measuring weight gain alone with antipsychotics could miss treatmentrelated increases in adiposity. Direct measures of adiposity such as dual-energy X-ray absorptiometry (DEXA) as well as sensitive and reliable measures of insulin resistance, lipid Batimastat metabolism, and glucose control, are needed in research studies of these medications to examine metabolic risk. A meta-analysis found a higher mortality with atypicals compared with placebo in older patients with dementia, resulting in a black -box warning for the entire class of atypicals. It remains unclear what the increased mortality resulted from, though possibilities include the sedating properties of these agents (leading to falls or aspiration pneumonia), QT prolongation (leading to arrhythmias and sudden cardiac death), venous thromboembolism leading to pulmonary embolism, and other cardiovascular or cerebrovascular events.101,102 It. is unknown whether these risks apply to nondemented elderly patients.