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Safe Prescribing in Dementia Patients

 

As a Psychiatrist with special interest in dementia care, I am frequently asked to advise on the management of the so called ‘non-cognitive’ or ‘behavioural and psychological’ symptoms of dementia. In short, the “challenging behaviour” which is so often one of the most distressing aspects of this devastating illness.

Since 2004 the increased risk of using antipsychotic medication in these circumstances has been well recognised, both in terms of increased risk of disability and death from stroke and also accelerated cognitive decline. Recent evidence (1) emerging from Harvard University and highlighted recently in the media (http://www.bbc.co.uk/news/health-17138683) reconfirms and adds to this evidence.

Antipsychotics should always be the last line of defence in the management of challenging behaviour, only considered when other pharmacological and non-medication approaches have been exhausted, and only at the lowest possible dose for the shortest possible time. That is “start low, go slow”.

As Psychiatrists it is our responsibility to work with both medical and non-medical professional colleagues as well as dementia sufferers and their carers to drive down the use of this medication at every opportunity. Furthermore we must ensure that when antipsychotic medication is required, it is rigorously monitored. In this way we can work together to reduce morbidity associated with the management of dementia.

I commend the BBC for keeping this issue in the spotlight.

1. K F Huybrechts, T Gerhard, et al. Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study. BMJ 2012; 344: e977

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