Risperidone, haloperidol, and olanzapine for the treatment of behavioral disturbances in nursing home patients: A retrospective analysis

Objective: This retrospective chart review assessed the efficacy and tolerability of risperidone, haloperidol, and olanzapine for the treatment of behavioral disturbances in nursing home patients with a psychiatric disorder. Methods: A review of similar to 10,000 patient charts from 61 nursing homes in New Jersey identified 202 patients treated for 1 to 12 months with risperidone (n = 105), haloperidol (n = 77), or olanzapine (n = 20). The primary target symptoms were behavioral (hitting, screaming, pacing) and psychiatric (hallucinations, paranoia, delusions). Improvement in frequency and severity of behavioral symptoms was measured based on physicians' progress notes, psychiatric consultation reports, and nurses' summaries and behavioral monitoring forms. Results: The most common diagnosis was dementia (n = 123), followed by schizophrenia (n = 32) and organic psychosis (n = 19). Among patients with dementia, behavioral symptoms improved in 55 of 65 (85%) patients treated with risperidone (1.1 mg/d), 18 of 42 (43%) treated with haloperidol (1.1 mg/d), and 7 of 16 (44%) treated with olanzapine (6.7 mg/d). Overall improvement in the target behavioral symptoms was seen in more patients treated with risperidone (80%) than in those treated with haloperidol (53%) or olanzapine (50%). Adverse effects were seen in 27 of 105 (26%) risperidone-treated patients, 26 of 77 (34%) haloperidol-treated patients, and 13 of 20 (65%) olanzapine-treated patients. Conclusions: The apparent efficacy of risperidone in treating behavioral disturbances in these patients, and its more favorable safety profile, support its use as first-line therapy when antipsychotic medication is necessary.