부산대학교 도서관

1. To use a case-based, interactive approach to facilitate recognition of EPS induced by antipsychotics, distinguish EPS from other common causes of agitation, and recommend management of EPS in the context of hospice and palliative medicine. 2. Discuss a practical intervention that clinicians can readily integrate into their clinical settings to improve antipsychotic prescribing practices to minimize medication-related adverse effects. Common antipsychotic side effects may be misdiagnosed as agitation near the end of life, resulting in a catch-22 of inappropriate antipsychotic dose escalation to treat medication-induced agitation, thus worsening patient discomfort. A practical and brief educational intervention can improve prescriber recognition of antipsychotic side-effects, reducing these medication-related adverse events and improving end-of-life care. Antipsychotics are valuable tools for palliating agitation, a common symptom near the end of life. However, over one-third of individuals treated with antipsychotics experience uncomfortable extrapyramidal side effects (also known as extrapyramidal symptoms or EPS). EPS, a consequence of dopamine blockade, encompasses a spectrum from drug-induced parkinsonism to involuntary movements to akathisia (a subjective sense of restlessness). EPS may be underrecognized in the palliative care setting, leading to a catch-22 of escalating antipsychotic doses for what is actually EPS-induced agitation. This risk is compounded by the advanced age and antipsychotic inexperience of most hospice patients, along with the common use of haloperidol, the antipsychotic with the highest EPS risk. In a series of four inpatient hospice cases, EPS secondary to haloperidol were misdiagnosed as worsening agitation, prompting inappropriate dose escalation. To address this issue, high-yield antipsychotic use recommendations were compiled and disseminated to eight inpatient hospice providers. Subsequently, all providers completed a survey evaluating the impact of the recommendations on clinical practice and patient symptoms. In each patient case, discontinuation of haloperidol resolved agitation, supporting EPS as the underlying etiology. As a result of the prescribing recommendations, the inpatient hospice admission orders were modified to reduce the dose and frequency of PRN haloperidol for agitation. Survey Results: overwhelmingly indicated that the intervention influenced antipsychotic prescribing practices and increased clinician confidence in EPS assessment. All prescribers expressed a strong desire for additional training on this subject for themselves and bedside nurses. EPS are common and underrecognized antipsychotic side effects that can precipitate inappropriate dose escalation and worsen discomfort near the end of life. Brief educational interventions can prime clinicians to consider EPS on the differential diagnosis of agitation refractory to antipsychotics and provide knowledge to treat these symptoms effectively. Pharmacotherapeutics / Pharmacopalliation / Managing Suffering and Distress [ABSTRACT FROM AUTHOR]