The DOI matches its Crossref record; 80 of the 80 references it cites were found in a registry or an index.
Efficacy and Comparative Effectiveness of Atypical Antipsychotic Medications for Off-Label Uses in Adults: A Systematic Review and Meta-analysis
Abstract
CONTEXT: Atypical antipsychotic medications are commonly used for off-label conditions such as agitation in dementia, anxiety, and obsessive-compulsive disorder. OBJECTIVE: To perform a systematic review on the efficacy and safety of atypical antipsychotic medications for use in conditions lacking approval for labeling and marketing by the US Food and Drug Administration. DATA SOURCES AND STUDY SELECTION: Relevant studies published in the English language were identified by searches of 6 databases (PubMed, EMBASE, CINAHL, PsycInfo, Cochrane DARE, and CENTRAL) from inception through May 2011. Controlled trials comparing an atypical antipsychotic medication (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, asenapine, iloperidone, or paliperidone) with placebo, another atypical antipsychotic medication, or other pharmacotherapy for adult off-label conditions were included. Observational studies with sample sizes of greater than 1000 patients were included to assess adverse events. DATA EXTRACTION: Independent article review and study quality assessment by 2 investigators. DATA SYNTHESIS: Of 12 228 citations identified, 162 contributed data to the efficacy review. Among 14 placebo-controlled trials of elderly patients with dementia reporting a total global outcome score that includes symptoms such as psychosis, mood alterations, and aggression, small but statistically significant effects sizes ranging from 0.12 and 0.20 were observed for aripiprazole, olanzapine, and risperidone. For generalized anxiety disorder, a pooled analysis of 3 trials showed that quetiapine was associated with a 26% greater likelihood of a favorable response (defined as at least 50% improvement on the Hamilton Anxiety Scale) compared with placebo. For obsessive-compulsive disorder, risperidone was associated with a 3.9-fold greater likelihood of a favorable response (defined as a 25% improvement on the Yale-Brown Obsessive Compulsive Scale) compared with placebo. In elderly patients, adverse events included an increased risk of death (number needed to harm [NNH] = 87), stroke (NNH = 53 for risperidone), extrapyramidal symptoms (NNH = 10 for olanzapine; NNH = 20 for risperidone), and urinary tract symptoms (NNH range = 16-36). In nonelderly adults, adverse events included weight gain (particularly with olanzapine), fatigue, sedation, akathisia (for aripiprazole), and extrapyramidal symptoms. CONCLUSIONS: Benefits and harms vary among atypical antipsychotic medications for off-label use. For global behavioral symptom scores associated with dementia in elderly patients, small but statistically significant benefits were observed for aripiprazole, olanzapine, and risperidone. Quetiapine was associated with benefits in the treatment of generalized anxiety disorder, and risperidone was associated with benefits in the treatment of obsessive-compulsive disorder; however, adverse events were common.
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“Three RCTs, all in care homes, evaluated music therapy by trained therapists using a specific protocol - typically involving warming up with a well-known song, listening to and then joining in with the music. 28-30”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [28]
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“The largest study, which included participants irrespective of agitation level, found music therapy twice a week for 6 weeks was effective compared with the usual care group. 28”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [28]
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Antipsychotics and Dementia: A Time for Restraint?
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Transformation of excess mortality in people with schizophrenia and bipolar disorder in Taiwan
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“As in many other countries, such extended use of SGAs in a broad range of non-psychotic mental illnesses (Alexander et al. 2011; Maher et al. 2011) had been happening in Taiwan.”
BackgroundMaxwell, C. J., Campitelli, M. A., Hogan, D. B., Diong, C. C., Austin, P. C., Amuah, J. E., Lapane, K. L., Seitz, D. P., Gill, S. S., Gruneir, A., et al. (2018) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4385 · Cited by 19
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GLP1 receptor agonism protects against acute olanzapine-induced hyperglycemia
Medak, K. D., Shamshoum, H., Peppler, W. T., & Wright, D. C. (2020) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00309.2020 · Cited by 21
Psychopharmacology of chronic pain
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“Although short-term use of antipsychotic drugs in older adults can modestly improve symptoms of agitation and aggression (2), it can also pose significant health risks, including higher risk of death.”
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“This may change though with increasing recognition that there can be limited clinical benefit of atypical antipsychotic drugs in some patients, alongside potentially life-threatening events (Titier et al., 2005; Maher et al., 2011), and with the possibility of new atypical antipsychotic drugs in the future.”
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“placebo), whereas the risk of a broadly defined category of cardiovascular events appeared to be increased to a similar degree with both risperidone and olanzapine, but not with quetiapine [7].”
BackgroundHoward, R. J., Costafreda, S. G., Karcher, K., Coppola, D., Berlin, J. A., & Hough, D. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.115.177683 · Cited by 20
“For example, depending on the atypical antipsychotic, the number of patients that would need to be treated to observe improvement in psychosis and aggression in a single patient ranges from 5 to 14 (5), with quetiapine having less convincing evidence for efficacy than risperidone and olanzapine (7,22).”
BackgroundRao, A. M., Suliman, A., Story, G. W., Vuik, S., Aylin, P. P., & Darzi, A. W. (2016) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1509 · Cited by 19
“BPSD also present a major challenge for those who provide care for people with dementia (Maher et al., 2011).”
BackgroundMethodPharmacotherapy for Anxiety Disorders.
O’Leary, K. B., & Khan, J. S. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.04.012 · Cited by 22
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“Nevertheless, a recent meta-analysis indicated limited efficacy of antipsychotics in dementia as a result of small effect size.(37) For conditions such as delirium, which is characterized by acute changes in levels of consciousness, it is important to identify the disease’s underlying causes, recognizing those that ca…”
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“AAPs are also prescribed for bipolar disorder, depression, dementia and anxiety disorders (Maher et al., 2011), and accordingly these patient populations may have different risk factors for the development of cataracts.”
BackgroundManagement of visual hallucinations in dementia and Parkinson’s disease
Swann, P., & O'Brien, J. T. (2018) · International Psychogeriatrics · doi:10.1017/s1041610218001400 · Cited by 21
Antipsychotic agents in anxiety disorders: An umbrella review
Garakani, A., Buono, F. D., Salehi, M., Funaro, M. C., Klimowicz, A., Sharma, H., Faria, C. G. F., Larkin, K., & Freire, R. C. R. (2024) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13669 · Cited by 17
“23”
BackgroundInfluentialCasamento, A. J., Neto, A. S., Lawrence, M., Chudleigh, L., Browne, E., Taplin, C., Eastwood, G. M., & Bellomo, R. (2023) · Journal of Critical Care · doi:10.1016/j.jcrc.2023.154343 · Cited by 17
Treatment patterns and characteristics of older antipsychotic users in Germany
Schmedt, N., Jobski, K., Kollhorst, B., Krappweis, J., Rüther, E., Schink, T., & Garbe, E. (2016) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000119 · Cited by 17
“We also found a high baseline prevalence of other mental disorders; however, it is difficult to determine whether AP polypharmacy in patients with dementia is related to pre-existing psychiatric morbidity or BPSD.”
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“As a result, most agents are used off-label due to the lack of other options (7).”
BackgroundRichtlijn diagnostiek en behandeling van dementie
Rikkert, M. G. M. O., van Exel, E. R., Knol, W. G., Lemstra, A. W., Roks, G., & Verhey, F. R. J. (2015) · Research Publications (Maastricht University) · Cited by 17
Delirium Superimposed on Dementia and Mild Cognitive Impairment
Roden, M., & Simmons, B. B. (2014) · Postgraduate Medicine · doi:10.3810/pgm.2014.10.2827 · Cited by 19
Atypical antipsychotics for older adults: are they safe and effective as we once thought?
Jeste, D. V., & Maglione, J. E. (2013) · Journal of Comparative Effectiveness Research · doi:10.2217/cer.13.33 · Cited by 18
“Atypical antipsychotics have also come to be widely used “off label” in the treatment of psychosis related to a variety of other psychiatric diagnoses [16] including dementia and post-traumatic stress disorder (PTSD) [10,11,14].”
BackgroundLópez‐Guarnido, O., Tabernero, M. J., Hernández, A. F., Rodrigo, L. S., & Bermejo, A. M. (2013) · Journal of Applied Toxicology · doi:10.1002/jat.2944 · Cited by 17
“Among SGAs, QTP is one of the most commonly prescribed (Alexander et al., 2011; Maher et al., 2011).”
BackgroundConsiderations in psychotropic treatments in dementia – can polypharmacy be avoided?
Ravona‐Springer, R., & Davidson, M. (2013) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145713000412 · Cited by 17
“, 2006a) and marginal (Ballard & Waite, 2006; Maher et al., 2011; Schneider et al., 2006a; Seitz et al., 2011) or lack of efficacy (Nelson & Devanand, 2011; Yury & Fisher, 2007) associated with administration of psychotropic medications to demented elderly, a recently published study demonstrated that their use has in…”
BackgroundThe geriatric mania asenapine study (GeMS)
Barak, Y., Finkelstein, I., & Pridan, S. (2016) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2016.01.012 · Cited by 16
NHG-Standaard Dementie (derde herziening)+
van Charante, E. P. M., Perry, M., Vernooij-Dassen, M. J. F. J., Boswijk, D., Stoffels, J., Achthoven, L., & Luning-Koster, M. N. (2012) · Cited by 16
Stock, K. J., Hogan, D. B., Lapane, K. L., Amuah, J. E., Tyas, S. L., Bronskill, S. E., Morris, A. M., Bell, C. M., Jeffs, L. P., & Maxwell, C. J. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.02.013 · Cited by 16
A controlled trial of quetiapine XR coadministration treatment of SSRI-resistant panic disorder
Goddard, A. W., Mahmud, W., Medlock, C. E., Shin, Y., & Shekhar, A. (2015) · Annals of General Psychiatry · doi:10.1186/s12991-015-0064-0 · Cited by 16
Rojas‐Fernandez, C. H., Mikhail, M., & Brown, S. G. (2014) · Annals of Pharmacotherapy · doi:10.1177/1060028013520196 · Cited by 16
“Of currently available medications, the evidence is strongest for risperidone, aripiprazole, and olanzapine.(5,21) We found that overall, 61% of residents with dementia were receiving antipsychotics, a proportion that is consistent with recent studies from the United States, Europe, and Scandinavia.”
ResultSemla, T. P., Lee, A. F., Gurrera, R. J., Bajor, L., Li, M., Miller, D. R., Smith, E. G., Wang, C., Wan, Y., Kazis, L. E., et al. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14897 · Cited by 16
“Antipsychotics have not consistently demonstrated effectiveness in managing behavioral complications associated with dementia.(6,7) Older adults prescribed an antipsychotic are at greater risk of death, stroke, falls, neurological and metabolic complications, and other adverse effects than those not prescribed an anti…”
BackgroundSawan, M. J., Jeon, Y., & Chen, T. F. (2018) · Drugs & Aging · doi:10.1007/s40266-018-0527-5 · Cited by 17
Bennie, M., Bishop, I., Godman, B., Barbui, C., Raschi, E., Campbell, S., Miranda, J., & Gustafsson, L. L. (2013) · International Journal of Clinical Practice · doi:10.1111/ijcp.12100 · Cited by 14
Vinași, R.-C., Buciuta, A., & Coman, H. G. (2021) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000358 · Cited by 16
“There is a high frequency in terms of adverse events as well as a high mortality risk associated with the administration of antipsychotic treatment (Maher et al., 2011; Tampi et al., 2016; Zhai et al., 2016; Yunusa et al., 2019; Tampi et al., 2020).”
BackgroundPrior, A., Laursen, T. M., Larsen, K. K., Johnsen, S. P., Christensen, J., Andersen, G., & Vestergaard, M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0084103 · Cited by 15
“Antipsychotics are used for several conditions including schizophrenia and other psychotic disorders, bipolar affective disorder, unipolar depression, personality disorders, post-traumatic stress disorder, obsessive compulsive disorder, Tourette’s syndrome, attention deficit hyperactivity disorder, and agitation in de…”
BackgroundYuen, I., & Kwok, T. C. Y. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5063 · Cited by 15
“Routinely used pharmacotherapy for agitation is now discouraged as benzodiazepines accelerate cognitive decline,(12) and antipsychotics increase mortality risk and are of limited efficacy.(13) Increasing attention has been paid on nonpharmacological interventions.”
BackgroundAntidepressants versus placebo for generalised anxiety disorder (GAD)
Kopcalic, K., Arcaro, J., Pinto, A., Ali, S., Barbui, C., Curatoli, C., Martin, J., & Guaiana, G. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012942.pub2 · Cited by 16
Antipsychotic off-label use in the 21st century: An enduring public health concern
Verdoux, H. (2025) · Dialogues in Clinical Neuroscience · doi:10.1080/19585969.2025.2449833 · Cited by 15
Brown, R. T., Shultz, K., Karlawish, J. H., Zhou, Y., Xie, D., & Ryskina, K. L. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17947 · Cited by 14
Antipsychotic medications and extreme weight gain in two health systems
Arterburn, D. E., Wood, G. C., Theis, M. K., Westbrook, E. O., Anau, J., Rukstalis, M. R., Boscarino, J. A., Daar, Z. S., & Gerhard, G. S. (2015) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2015.08.012 · Cited by 14
Anticholinergic medicines use among older adults before and after initiating dementia medicines
Narayan, S. W., Pearson, S., Litchfield, M. J., Couteur, D. G. L., Buckley, N. A., McLachlan, A. J., & Zoëga, H. (2019) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.13976 · Cited by 14
Evidence-Based Pharmacotherapy of Generalised Anxiety Disorder: Focus on Agomelatine
Stein, D. J. (2021) · Advances in Therapy · doi:10.1007/s12325-021-01860-1 · Cited by 18
“Second-generation (‘atypical’) antipsychotics (SGAs) are used offlabel for anxiety (quetiapine showing significant benefit in GAD [12, 13]), but have failed to gain regulatory approval for the treatment of GAD because of safety concerns.”
BackgroundFreund‐Levi, Y., Bloniecki, V., Auestad, B., Tysen-Bäckström, A. C., Lärksäter, M., & Aarsland, D. (2014) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000362204 · Cited by 14
Tampi, R. R., Tampi, D. J., & Balachandran, S. (2017) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-017-0104-2 · Cited by 14
Atypical Antipsychotic Use and Parkinsonism in Dementia: Effects of Drug, Dose, and Sex
Marras, C., Herrmann, N., Anderson, G., Fischer, H. D., Wang, X., & Rochon, P. A. (2012) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2012.11.001 · Cited by 14
Pharmacogenetics of neurological and psychiatric diseases at older age: has the time come?
Lozupone, M., Panza, F., Stella, E., Montagna, M. L., Bisceglia, P., Miscio, G., Galizia, I., Daniele, A., Mauro, L. D., Bellomo, A., et al. (2016) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2017.1246533 · Cited by 16
Yunusa, I. U., Teng, C., Karaye, I. M., Crounse, E., Alsahali, S. M., & Maleki, N. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.917351 · Cited by 13
Melatonin for Insomnia in Medical Inpatients: A Narrative Review
Salahub, C. M., Wu, P. E., Burry, L. D., Soong, C., Sheehan, K., MacMillan, T. E., & Lapointe‐Shaw, L. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm12010256 · Cited by 12
“In older adults with dementia, atypical antipsychotic use has been associated with an increased risk of stroke [63] and death [64].”
BackgroundPrescription Pattern and Off-Label Use of Antipsychotics in a Middle Eastern Population
Bastaki, K., Anbari, M. E., Ghuloum, S., & Jithesh, P. V. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.753845 · Cited by 13
“For example, the discontinuation of thioridazine use was based on reported evidence of severe cardiac arrhythmias (Maher, 2011; McKean and Monasterio, 2012).”
Prevalence and Appropriateness of Antipsychotic Prescribing in an Italian Prison
Pelizza, L., Maestri, D., Paulillo, G., & Pellegrini, P. (2021) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000001495 · Cited by 14
Relationship between Antipsychotics and Weight in Patients with Prader–Willi Syndrome
Elliott, J. P., Cherpes, G., Kamal, K. M., Chopra, I., Harrison, C., Riedy, M. C., Herk, B., McCrossin, M., & Kalarchian, M. A. (2015) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.1558 · Cited by 13
Chapter 18. Personality Disorders
Chapman, B. P., & Simning, A. (2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615375196.ds18 · Cited by 12
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“Several secondgeneration antipsychotics have gained additional FDA indications for once off-label conditions, for example, adjunctive treatment of depression and irritability associated with autistic disorder, but the preponderance of evidence supporting use of secondgeneration antipsychotics relates to treatment of s…”
BackgroundAnxiety disorders in older people
Lindesay, J. E. B., Stewart, R. J., & Bisla, J. (2012) · Reviews in Clinical Gerontology · doi:10.1017/s0959259812000019 · Cited by 15
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“…is commonly used off-label for a variety of conditions, one of which is insomnia (Cohrs et al. 2004; Hartung et al. 2008; Philip et al. 2008; Wine et al. 2009; Dolder and McKinsey 2010), although results from a meta-analysis described quetiapine efficacy as inconclusive (Maher et al. 2011).”
Atypical Antipsychotics: Trends in Analysis And Sample Preparation of Various Biological Samples
Fragou, D., Dotsika, S., Sarafidou, P. C., Samanidou, V., Njau, S. N., & Kovatsi, L. (2012) · Bioanalysis · doi:10.4155/bio.12.55 · Cited by 12
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“Studies have been conducted in various settings to examine the complex context of psychotropic medicine use [38].”
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The antipsychotic paradox: Lessons regarding determinants of premature mortality
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Discovering interactions in polypharmacy: Impact of metamizole on the metabolism of quetiapine
Watermeyer, F., Gaebler, A. J., Neuner, I., Haen, E., Hiemke, C., Schoretsanitis, G., & Paulzen, M. (2024) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.16168 · Cited by 11
“Accordingly, the proportions of patients with plasma concentrations below or above the lower limit of the TRR significantly differed between groups ( χ 2 [1] = 4.36, P = .037).”
InfluentialA Review On Huntington Protein: Insight Into Protein Aggregation and Therapeutic Interventions
Ekambaram, S., Ram, V., & Rajasekaran, R. (2022) · Current Drug Metabolism · doi:10.2174/1389200223666220321103942 · Cited by 11
Non-Antidepressant Treatment of Generalized Anxiety Disorder
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“…a t test and b one-way ANOVA followed by Bonferroni’s post hoc test, N= 7–8 aripiprazole, and risperidone—since the recent meta-analysis had revealed that all these drugs produced a small but significant improving effect on behavioral symptoms of dementia in elderly patients (Maher et al. 2011).”
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Psychotropic drugs and CYP2D6 in late-life psychiatric and neurological disorders. What do we know?
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Makary, S., Moez, K. A. E., El‐Sayed, M. M., & Hassan, H. (2023) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-023-00612-y · Cited by 10
“A decreased activity secondary to sedative effects was noted especially olanzapine, quetiapine, and risperidone which are associated with sedation [35] leading to iatrogenic weight gain and diabetes.”
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Characteristics and trends of low‐dose quetiapine use in two western state Medicaid programs
Hartung, D. M., Zerzan, J. T., Yamashita, T. E., Tong, S., Morden, N. E., & Libby, A. M. (2013) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.3538 · Cited by 10
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“3) Gender Male 8 (28) 7 (22) 6 (19) 5 (26) 6 (27) 4 (22) Female 21 (72) 25 (78) 25 (81) 14 (74) 16 (73) 14 (78) Ethnic group, n (%) White 22 (76) 22 (71) 22 (73) 16 (84) 15 (71) 11 (65) Black 7 (24) 7 (23) 6 (20) 3 (16) 5 (24) 4 (24) Mixed 1 (3) Other 1 (3) 2 (7) 1 (5) 2 (12) Home circumstances, n (%) Alone 23 (79) 20…”
Nudging Physicians to Reduce Quetiapine Prescribing Using Medicare Letters
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Management of neuropsychiatric symptoms in dementia
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“In recent years, antipsychotic drugs have been increasingly prescribed for other mental disorders, even off-label indications [2].”
Behavioral and Psychological Symptoms (BPSD) in Alzheimer’s Disease (AD): Development and Treatment
Lee, H. H., Chinna‐Meyyappan, A., Feldman, O. J., Marotta, G., Survilla, K., & Lanctôt, K. L. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_566 · Cited by 10
Metadata
- Authors
- Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J.-H., Ewing, B., Wang, Z., Timmer, M., Sultzer, D., & Shekelle, P. G.
- Affiliations
- RAND Corporation (US)
- United States Department of Veterans Affairs (US)
- University of California, Los Angeles (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2011-09-28
- Volume
- 306
- Issue
- 12
- Pages
- 1359
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2072303299
- Cited by
- 558
- References
- 80
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 22 · 2023: 24 · 2022: 63 · 2021: 39 · 2020: 31 · 2019: 29 · 2018: 33 · 2017: 35 · 2016: 52 · 2015: 50 · 2014: 55 · 2013: 52 · 2012: 45
- FWCI
- 33.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (HHSA2902007100621)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- atypical antipsychotics, off-label drug use, generalized anxiety disorder, obsessive-compulsive disorder, risperidone, olanzapine, quetiapine, aripiprazole, extrapyramidal symptoms, stroke risk, adverse drug reactions, comparative effectiveness, elderly patients, treatment efficacy and safety, number needed to harm
- MeSH terms
- Adult, Aged, Anxiety Disorders, Dementia, Humans, Middle Aged, Obsessive-Compulsive Disorder, Antipsychotic Agents, United States, United States Food and Drug Administration, Treatment Outcome, Off-Label Use
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