{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T12:10:09Z","timestamp":1731154209337,"version":"3.28.0"},"reference-count":78,"publisher":"American Society of Consultant Pharmacists","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["sr care pharm"],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:p>The history of antipsychotics in nursing facilities is one piece of a much larger, more complex puzzle. In many ways, it reflects the virtues and limitations of the entire health care system and those who provide care. None of the issues related to the use of antipsychotics are specific to these medications or to nursing facilities. After decades of effort to reduce unwarranted antipsychotics use, the current situation is still a work in progress. Many widely held assumptions and standard narratives, such as those about behavior, the place of medications in person-centered care, and the causes of inappropriate medication use are only partially correct. This second of three articles is not intended to discuss how to diagnose and manage behavior disorders or choose medications. Instead, it addresses the diverse perspectives and key players that have been involved and the results of their efforts. Ultimately, this will set the stage for specific recommendations (part 3) about learning from past efforts surrounding antipsychotics to identify more definitive and lasting improvements in the future. Part 1 of this series covered the history of attempts to influence use of medications\u2014especially, antipsychotics\u2014in nursing facility care of residents with behavior, mood, and cognitive issues. These improvement efforts can be described as fragmented, often ineffectual, and politically fraught. After decades of effort, and despite a significant reduction in the indiscriminate use of antipsychotics, psychotropics are still widely used in nursing facilities.<jats:sup>1<\/jats:sup>The extent of improvement overall in managing individuals with dementia and other diverse behavior, mood, and cognitive issues is unclear.<\/jats:p>","DOI":"10.4140\/tcp.n.2024.57","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T12:24:08Z","timestamp":1706531048000},"page":"57-72","source":"Crossref","is-referenced-by-count":0,"title":["Antipsychotics: Past, Present, and Future (Part 2): Article 2 of 3"],"prefix":"10.4140","volume":"39","author":[{"given":"Steven","family":"Levenson","sequence":"first","affiliation":[{"name":"Post-Acute Long-term Care physician and medical director."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2625","reference":[{"year":"2022","key":"ref1","article-title":"Long-term Trends of Psychotropic Drug Use in Nursing Homes."},{"key":"ref2","article-title":"Inertia and decision making.","volume":"7","year":"2016","journal-title":"Front Psychol."},{"key":"ref3","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1027\/1016-9040\/a000320","article-title":"Decision inertia in critical incidents.","volume":"24","year":"2019","journal-title":"Eur Psychol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1258\/jrsm.2011.110180","article-title":"The answer is 17 years, what is the question: understanding time lags in translational research.","volume":"104","year":"2011","journal-title":"JR Soc Med."},{"key":"ref5","first-page":"709","article-title":"Why are we so slow to adopt some evidence-based practices?","volume":"98","year":"2018","journal-title":"Am Fam Physician."},{"year":"2023","key":"ref6","article-title":"State Operations Manual: Appendix PP \u2013 Guidance to Surveyors For Long Term Care Facilities (Publication 100-07, Revision 211, 2\/3\/2023)."},{"key":"ref7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s11920-006-0023-1","article-title":"Delusions in the nonclinical population.","volume":"8","year":"2006","journal-title":"Curr Psychiatry Rep."},{"key":"ref8","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1111\/j.1532-5415.2007.01156.x","volume":"55","year":"2007","journal-title":"J Am Geriatr Soc."},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.2105\/AJPH.74.10.1118","article-title":"Behavioral problems among patients in skilled nursing facilities.","volume":"74","year":"1984","journal-title":"Am J Public Health."},{"key":"ref10","doi-asserted-by":"crossref","first-page":"409","DOI":"10.3928\/0048-5713-19950701-09","article-title":"Epidemiology of psychiatric disturbances in nursing homes.","volume":"25","year":"1995","journal-title":"Psychiatric Annuals."},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1017\/S1041610210000608","article-title":"Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review.","volume":"22","year":"2010","journal-title":"Int Psychogeriatr."},{"key":"ref12","first-page":"41","article-title":"Nursing Home Care in the United States: Failure in Public Policy Supporting Paper No. 2. Drugs in Nursing Homes: Misuse, High Costs, and Kickbacks.","year":"1975","journal-title":"Special Committee on Aging."},{"key":"ref13","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1001\/jamapsychiatry.2021.4377","article-title":"Longitudinal associations of mental disorders with dementia: 30-year analysis of 1.7 million New Zealand citizens.","volume":"79","year":"2022","journal-title":"JAMA Psychiatr."},{"article-title":"Major Neurocognitive Disorder (dementia) [Updated November 19, 2022].","volume-title":"In StatPearls [Internet]","year":"2023","key":"ref14"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1016\/j.jamda.2022.03.017","article-title":"Impact of psychotic symptoms and concurrent neuropsychiatric symptoms on the quality of life of people with dementia living in nursing homes.","volume":"23","year":"2022","journal-title":"J Am Med Dir Assoc."},{"key":"ref16","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/00019442-200301000-00011","article-title":"The epidemiology of psychosis in dementia.","volume":"11","year":"2003","journal-title":"Am J Geriatr Psychiatry."},{"key":"ref17","first-page":"100","volume":"50","year":"2008","journal-title":"Med Lett Drugs Ther."},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.jamda.2019.05.022","article-title":"When less is more, but still not enough: why focusing on limiting antipsychotics in people with dementia is the wrong policy imperative.","volume":"20","year":"2019","journal-title":"J Am Med Dir Assoc."},{"key":"ref19","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jamda.2017.01.005","article-title":"Reforming management of behavior symptoms and psychiatric conditions in long-term care facilities: a different perspective.","volume":"18","year":"2017","journal-title":"J Am Med Dir Assoc."},{"key":"ref20","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4103\/0973-1229.104497","article-title":"Polypharmacy in psychiatry: a review.","volume":"11","year":"2013","journal-title":"Mens Sana Monogr."},{"key":"ref21","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1001\/jama.2021.1195","volume":"325","year":"2021","journal-title":"JAMA."},{"issue":"6","key":"ref22","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/YIC.0000000000000417","article-title":"The dilemma of polypharmacy in psychosis: is it worth combining partial and full dopamine modulation?.","volume":"37","year":"2022","journal-title":"Int Clin Psychopharmacol."},{"journal-title":"Adv Psychiatr Treat.","article-title":"Potentially hazardous drug interactions with psychotropics.","year":"2005","key":"ref23"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s11920-012-0284-9","article-title":"Clinically significant psychotropic drug-drug interactions in the primary care setting.","volume":"14","year":"2012","journal-title":"Curr Psychiatry Rep."},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.jamda.2023.08.014","article-title":"Appropriate antipsychotic use in nursing home populations: a wakeup call to CMS.","volume":"24","year":"2023","journal-title":"J Am Med Dir Assoc."},{"issue":"4","key":"ref26","doi-asserted-by":"crossref","first-page":"504","DOI":"10.21037\/apm.2019.03.06","article-title":"Benzodiazepines and\/or neuroleptics for the treatment of delirium in palliative care? A critical appraisal of recent randomized controlled trials.","volume":"8","year":"2019","journal-title":"Ann Palliat Med."},{"issue":"2","key":"ref27","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s11126-020-09839-x","article-title":"Clozapine for treatment-refractory aggressive behavior.","volume":"92","year":"2021","journal-title":"Psychiatr Q."},{"year":"2023","key":"ref28","article-title":"Medscape Drugs and Diseases."},{"issue":"2","key":"ref29","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/JCP.0000000000000665","article-title":"Activating and sedating adverse effects of second-generation antipsychotics in the treatment of schizophrenia and major depressive disorder: absolute risk increase and number needed to harm.","volume":"37","year":"2017","journal-title":"J Clin Psychopharm."},{"key":"ref30","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1001\/archinternmed.2009.456","article-title":"Impact of FDA black box advisory on antipsychotic medication use.","volume":"170","year":"2010","journal-title":"Arch Intern Med."},{"key":"ref31","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.jamda.2015.03.015","article-title":"The mortality risk of conventional antipsychotics in elderly patients: a systematic review and meta-analysis of randomized placebo-controlled trials.","volume":"16","year":"2015","journal-title":"J Am Med Dir Assoc."},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1176\/ajp.154.10.1360","article-title":"Mortality of elderly patients with psychiatric disorders.","volume":"154","year":"1997","journal-title":"Am J Psychiatry."},{"key":"ref33","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1176\/appi.ajp.2013.12081046","article-title":"The long-term effects of conventional and atypical antipsychotics in patients with probable Alzheimer\u2019s disease.","volume":"170","year":"2013","journal-title":"Am J Psych."},{"year":"2023","key":"ref34","article-title":"Understanding Unapproved Use of Approved Drugs \u201cOff Label.\u201d"},{"key":"ref35","first-page":"781","article-title":"Drug, patient, and physician characteristics associated with off-label prescribing in primary care.","volume":"172","year":"2012","journal-title":"Arch Intern Med."},{"key":"ref36","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.mayocp.2012.04.017","article-title":"Ten common questions (and their answers) about off-label drug use.","volume":"87","year":"2012","journal-title":"Mayo Clin Proc."},{"key":"ref37","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ajp.2009.01.005","article-title":"An analysis of the high psychotropic off-label use in psychiatric disorders: the majority of psychiatric diagnoses have no approved drug.","volume":"2","year":"2009","journal-title":"Asian J Psychiatr."},{"key":"ref38","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/jgs.18119","article-title":"Antiepileptic prescribing to persons living with dementia residing in nursing homes: a tale of two indications.","volume":"71","year":"2023","journal-title":"J Am Geriatr Soc."},{"key":"ref39","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/jgs.18117","article-title":"Anticonvulsant use in persons living with dementia: when is it justified?","volume":"71","year":"2023","journal-title":"J Am Geriatr Soc."},{"journal-title":"Cochrane Database Syst Rev.","article-title":"Valproate preparations for agitation in dementia.","year":"2018","key":"ref40"},{"journal-title":"Health Aff.","article-title":"Regulating nursing homes: are we learning from experience?","year":"2001","key":"ref41"},{"key":"ref42","first-page":"1994","article-title":"Effect of the Omnibus Reconciliation Act 1987 on antipsychotic prescribing in nursing home residents.","volume":"42","journal-title":"J Am Geriatr Soc."},{"year":"1986","key":"ref43"},{"key":"ref44","first-page":"129","article-title":"Nursing home regulation: history and expectations.","year":"1988","journal-title":"Health Care Financ Rev."},{"key":"ref45","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1111\/j.1365-2125.2012.04413.x","article-title":"Balanced prescribing - principles and challenges.","volume":"74","year":"2012","journal-title":"Br J Clin Pharmacol."},{"key":"ref46","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1377\/hlthaff.2018.0725","article-title":"Absorption for enhancing electronic prescribing safety.","volume":"37","year":"2018","journal-title":"Health Aff."},{"key":"ref47","doi-asserted-by":"crossref","first-page":"718302","DOI":"10.3389\/fresc.2021.718302","article-title":"Effects of nonpharmacological interventions on disruptive vocalisation in nursing home patients with dementia: a systematic review.","volume":"2","year":"2022","journal-title":"Front Rehabil Sci."},{"year":"2023","key":"ref48","article-title":"Quality Measures."},{"key":"ref49","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1001\/jamainternmed.2018.0379","article-title":"Association of the Centers for Medicare & Medicaid services\u2019 national partnership to improve dementia care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014.","volume":"178","journal-title":"JAMA Intern Med."},{"key":"ref50","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1111\/jgs.18276","article-title":"Unintended impacts of a national antipsychotic reduction initiative among nursing facility residents with and without Alzheimer\u2019s disease.","volume":"71","year":"2023","journal-title":"J Am Geriatr Soc."},{"key":"ref51","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.eurpsy.2019.01.014","article-title":"The pharmacological management of agitated and aggressive behaviour: a systematic review and meta-analysis.","volume":"57","year":"2019","journal-title":"Eur Psychiatry."},{"key":"ref52","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/ijnp\/pyz068","article-title":"Antipsychotic polypharmacy: a dirty little secret or a fashion?","volume":"23","year":"2020","journal-title":"Int J Neuropsychopharmacol."},{"key":"ref53","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1001\/archgenpsychiatry.2009.175","article-title":"National trends in psychotropic medication polypharmacy in office-based psychiatry.","volume":"67","year":"2010","journal-title":"Arch Gen Psychiatry."},{"key":"ref54","article-title":"Nader and Six Young Assistants Call on the Federal Government to Raise Nursing Home Standards."},{"year":"2022","key":"ref55","article-title":"OIG Report Shows Failures to Stop Illegal Drugging."},{"key":"ref56","first-page":"34","article-title":"Residents first. A long-term care facility introduces a social model that puts residents in control.","volume":"75","year":"1994","journal-title":"Health Prog."},{"key":"ref57","first-page":"261","article-title":"\u201cThat model is sooooo last millennium!\u201d Residential long term care as a system, not a place.","volume":"23","year":"2008","journal-title":"J Hous Elderly."},{"key":"ref58","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1093\/geront\/41.3.293","article-title":"Long-term care and a good quality of life: bringing them closer together.","volume":"41","year":"2001","journal-title":"Gerontol."},{"key":"ref59","doi-asserted-by":"crossref","first-page":"46958018787043","DOI":"10.1177\/0046958018787043","article-title":"Culture change in nursing homes: what is the role of nursing home resources?","volume":"55","year":"2018","journal-title":"Inquiry."},{"key":"ref60","first-page":"S6","article-title":"What does the evidence really say about culture change in nursing homes?","volume":"1","year":"2014","journal-title":"Gerontol."},{"key":"ref61","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jamda.2021.07.028","article-title":"The benefits of culture change in nursing homes-obtaining nationally representative evidence.","volume":"23","year":"2022","journal-title":"J Am Med Dir Assoc."},{"year":"2013","key":"ref62","article-title":"Examining inappropriate use of antipsychotic drugs [Internet]."},{"key":"ref63","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1111\/j.1532-5415.1992.tb01994.x","article-title":"Psychotherapeutic medications in the nursing home.","volume":"40","year":"1992","journal-title":"J Am Geriatr Soc."},{"year":"2011","key":"ref64","article-title":"Clinical Practice Guidelines We Can Trust."},{"key":"ref65","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1017\/S1041610218000534","article-title":"Management of behavioral and psychological symptoms in people with Alzheimer\u2019s disease: an international Delphi consensus.","volume":"31","year":"2019","journal-title":"Int Psychogeriatr."},{"key":"ref66","doi-asserted-by":"crossref","first-page":"583","DOI":"10.4140\/TCP.n.2011.583","volume":"26","year":"2011","journal-title":"Consult Pharm."},{"key":"ref67","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1176\/appi.ajp.2015.173501","article-title":"The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia.","volume":"173","year":"2016","journal-title":"Am J Psychiatry."},{"key":"ref68","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.jamda.2009.05.002","article-title":"The basis for improving and reforming longterm care, part 2: clinical problem solving and evidence-based care.","volume":"10","year":"2009","journal-title":"J Am Med Dir Assoc."},{"key":"ref69","doi-asserted-by":"crossref","first-page":"80","DOI":"10.7861\/clinmedicine.18-1-80","article-title":"When psychiatric symptoms reflect medical conditions.","volume":"18","year":"2018","journal-title":"Clin Med."},{"key":"ref70","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S1525-8610(04)70166-8","article-title":"Medication errors and adverse drug events in nursing homes: problems, causes, regulations, and proposed solutions.","volume":"2","year":"2001","journal-title":"J Am Med Dir Assoc."},{"key":"ref71","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.carage.2020.12.014","article-title":"Clarifying and improving the role of the psychiatric consultant.","volume":"22","year":"2021","journal-title":"Caring Ages."},{"key":"ref72","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1176\/ajp.144.11.1412","article-title":"Psychiatry and the nursing home.","volume":"144","year":"1987","journal-title":"Am J Psychiatr."},{"journal-title":"Psychiatry Online.","article-title":"Practical geriatrics: psychiatric consultation to nursing homes.","year":"1999","key":"ref73"},{"key":"ref74","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1176\/appi.ajp.158.10.1579","article-title":"Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1950-2000: a review.","volume":"158","year":"2001","journal-title":"Am J Psychiatry."},{"year":"2014","key":"ref75","article-title":"DSM-5 Handbook of Differential Diagnosis: American Psychiatric Publishing"},{"year":"1999","key":"ref76","article-title":"Why Employees Don\u2019t Do What They\u2019re Supposed to Do; and What to Do About It."},{"key":"ref77","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1093\/schbul\/5.4.560","article-title":"Psychiatric diagnostic error.","volume":"5","year":"1979","journal-title":"Schizophr Bull."},{"key":"ref78","first-page":"389","article-title":"Diagnosis and treatment of psychiatric disorders in medically ill inpatients.","volume":"42","year":"1991","journal-title":"Hosp Community Psychiatry."}],"container-title":["The Senior Care Pharmacist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/ascp\/tscp\/2024\/00000039\/00000002\/art00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T11:54:38Z","timestamp":1731153278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.4140\/TCP.n.2024.57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,1]]},"references-count":78,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2,1]]}},"alternative-id":["2639-9636(20240201)39:2L.57;1-"],"URL":"https:\/\/doi.org\/10.4140\/tcp.n.2024.57","relation":{},"ISSN":["2639-9636"],"issn-type":[{"type":"print","value":"2639-9636"}],"subject":[],"published":{"date-parts":[[2024,2,1]]}}}