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      Antipsychotic Drug Use and Community-Acquired Pneumonia

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          Abstract

          Antipsychotics are generally distinguished as atypical and typical agents, which are indicated in the treatment of acute and chronic psychoses and other psychiatric disorders. In April 2005, the US Food and Drug Administration issued a warning about the increased risk of all-cause mortality associated with atypical antipsychotic use in elderly patients with dementia. Pneumonia was one of the most frequently reported causes of death. The same warning was extended to typical antipsychotics in June 2008. In recent years, several observational studies have further explored the association between antipsychotic use, mainly in elderly patients, and the risk of fatal/nonfatal community-acquired pneumonia. The aim of this review is to revise and discuss the scientific evidence and biologic explanations for the association between atypical and typical antipsychotic use and pneumonia occurrence. Some general recommendations to clinicians are proposed to prevent the risk of pneumonia in patients requiring antipsychotic treatment.

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          Most cited references34

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          Confounding by indication: an example of variation in the use of epidemiologic terminology.

          Confounding by indication is a term used when a variable is a risk factor for a disease among nonexposed persons and is associated with the exposure of interest in the population from which the cases derive, without being an intermediate step in the causal pathway between the exposure and the disease. However, in the literature, the term confounding by indication is not always used consistently. The authors found three different situations in which the term has been applied or might have been used but was not: confounding by indication as protopathic bias, as confounding by severity, or as a form of selection bias. It might be helpful to limit use of the term confounding by indication to the situation in which the disease that forms the indication acts as a confounder irrespective of its severity and to apply the term confounding by severity if the severity of this disease acts as a confounder. Protopathic bias and selection bias should not be confused with these terms. The use of appropriate terms ultimately will improve communication among researchers and contribute to the clarity of their papers.
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            Aspiration pneumonia and dysphagia in the elderly.

            Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in the elderly, and the leading cause of death among residents of nursing homes. Oropharyngeal aspiration is an important etiologic factor leading to pneumonia in the elderly. The incidence of cerebrovascular and degenerative neurologic diseases increase with aging, and these disorders are associated with dysphagia and an impaired cough reflex with the increased likelihood of oropharyngeal aspiration. Elderly patients with clinical signs suggestive of dysphagia and/or who have CAP should be referred for a swallow evaluation. Patients with dysphagia require a multidisciplinary approach to swallowing management. This may include swallow therapy, dietary modification, aggressive oral care, and consideration for treatment with an angiotensin-converting enzyme inhibitor.
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              Community-acquired pneumonia in the elderly.

              T Marrie (2000)
              Pneumonia in the elderly is a common and serious problem with a clinical presentation that can differ from that in younger patients. Older patients with pneumonia complain of significantly fewer symptoms than do younger patients, and delirium commonly occurs. Indeed, delirium may be the only manifestation of pneumonia in this group of patients. Alcoholism, asthma, immunosuppression, and age >70 years are risk factors for community-acquired pneumonia in the elderly. Among nursing home residents, the following are risk factors for pneumonia: advanced age, male sex, difficulty in swallowing, inability to take oral medications, profound disability, bedridden state, and urinary incontinence. Streptococcus pneumoniae is the most common cause of pneumonia among the elderly. Aspiration pneumonia is underdiagnosed in this group of patients, and tuberculosis always should be considered. In this population an etiologic diagnosis is rarely available when antimicrobial therapy must be instituted. Use of the guidelines for treatment of pneumonia issued by the Infectious Diseases Society of America, with modification for treatment in the nursing home setting, is recommended.
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                Author and article information

                Contributors
                +31-10-7044128 , +31-10-7044712 , g.trifiro@erasmusmc.nl
                Journal
                Curr Infect Dis Rep
                Current Infectious Disease Reports
                Current Science Inc. (New York )
                1523-3847
                1534-3146
                11 March 2011
                11 March 2011
                June 2011
                : 13
                : 3
                : 262-268
                Affiliations
                [1 ]Department of Medical Informatics, Erasmus University Medical Center, Dr Molewaterplein 50, 3000 DR, Rotterdam, The Netherlands
                [2 ]IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
                Article
                175
                10.1007/s11908-011-0175-y
                3085099
                21394430
                6efd2112-daf1-4bf8-8d7d-3ee9fc0a15d3
                © The Author(s) 2011
                History
                Categories
                Article
                Custom metadata
                © Springer Science+Business Media, LLC 2011

                Infectious disease & Microbiology
                antipsychotic agents,aspiration pneumonia,phenothiazines,atypical antipsychotics,butyrophenones,drug toxicity,aged,pneumonia

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