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An audit of psychotropic prescribing practice of general adult psychiatrists in elderly demented patients

Published online by Cambridge University Press:  13 June 2014

Anna Maria Meaney  and
Colm Cooney
Anna Maria Meaney
Affiliation:
Cork University Hospital, Cork, Ireland
Colm Cooney
Affiliation:
St. Vincent's Hospital, Elm Park, Dublin 4, Ireland
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Abstract

Objectives: In Ireland elderly patients with behavioural and psychological symptoms of dementia (BPSD) are frequently prescribed anti-psychotic and other psychotropic agents. Elderly patients with dementia are more sensitive to adverse effects of medications. Despite this, little is known of the psychotropic prescribing practice of psychiatrists who treat this population. General adult psychiatrists in the Republic of Ireland continue to treat elderly patients with BPSD. The aim of this audit was to identify the prescribing practice of general adult psychiatrists in elderly patients with BPSD. We compare this practice to that of old age psychiatrists in the UK and that recommended by the American Psychiatric Association in 1997.

Methods: We devised a structured anonymous questionnaire, which was forwarded to all general adult psychiatrists in the Republic of Ireland.

Results: Atypical anti-psychotics are frequently prescribed by general adult psychiatrists to manage BPSD in elderly patients. The anti-psychotic agent of first preference chosen to treat psychotic symptoms in dementia is risperidone. Overall, sedative typical anti-psychotics are still the most frequently chosen anti-psychotic agents, chosen to manage behavioural symptoms in dementia. Benzodiazepines and trazadone are the most frequently prescribed other psychotropic agents chosen to manage agitated behaviour. In general the median doses of antipsychotics and other psychotropic medication used are in keeping with both the APA guidelines and practice of old age psychiatrists in the UK. A minority of practitioners (10%) specified at least one dosage regime that was grossly outside recommended ranges.

Conclusions: Overall, prescribing practice in terms of choice of treatment and dosage regime, of general adult psychiatrists in BPSD is in keeping with the best practice guidelines. However, sedating typical anti-psychotics and on occasion extraordinarily high doses of anti-psychotics are still prescribed.

Keywords

ElderlyDementiaPsychiatristPsychotropicPrescribing practice
Type
Audits
Information
Irish Journal of Psychological Medicine , Volume 20 , Issue 2 , June 2003 , pp. 59 - 64
Copyright
Copyright © Cambridge University Press 2003

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References

1.Ballard, C, Bannister, C, Graham, C, Oyebode, F, Wilcock, G. Associations of psychotic symptoms in dementia suffers. Br J Psychiatry 1995 Oct; 167(4):537–40.CrossRefGoogle Scholar
2.Rebok, GW, Folstein, MF. Dementia. J Neuropsychiatry Clin Neurosci, 1993 Summer; 5(3): 265–76.Google ScholarPubMed
3.Aronson, MK, Post, DC, Guastadisegni, P. Dementia, agitation and care in the nursing home. J Am Geriatr Soc 1993; 41(5): 507–512.CrossRefGoogle ScholarPubMed
4.Deimling, GT, Bass, DM. Symptoms of mental impairment among elderly adults and their effects on family caregivers. J Gerontol 1986; 41(6):778–784.CrossRefGoogle ScholarPubMed
5.Finkel, S. Behaviour and psychological signs and symptoms of dementia: Implications for research and treatment. Int Psychogeriatr 1996;8(suppl 3) 497–500.CrossRefGoogle ScholarPubMed
6.Lantz, MS, Marin, D. Pharmacological treatment of agitation in dementia: a comprehensive review. J Geriatr Psychiatry Neurol 1996 July;9(3):107–19.CrossRefGoogle ScholarPubMed
7.Zaudig, M. A risk benefit assessment of risperidone for the treatment of behaviour and psychological symptoms in patients with dementia. Drug Saf, 2000 Sep; 23(3): 183–95.CrossRefGoogle Scholar
8.Condren, RM, Cooney, C. Use of drugs by old age psychiatrists in the treatment of psychotic and behavioural symptoms in patients with dementia. Aging Mental Health 2001 Aug;5(3):235–41.CrossRefGoogle ScholarPubMed
9.American Psychiatric Association Guidelines 1997. Practice guidelines for the treatment of patients with Alzheimers disease and other dementias of late life. Am J Psychiatry May 1997(5 suppl): 1–39.Google Scholar
10.Tariot, PN. Treatment strategies for agitation and psychosis in dementia. J Clin Psychiatry 1996; 57(suppl 14): 1–39.Google ScholarPubMed
11.Thacker, S, Jones, R. Neuroleptic prescribing to the community elderly in Nottingham. Int J Geriatric Psychiatry Aug;12(8)12:833–837.3.0.CO;2-8>CrossRefGoogle Scholar
12.Schneider, LS, Pollock, VE, Lyness, SA. Ameta-analysis of controlled trials of neuroleptic treatment in dementia. J Am Geriatr Soc 1990;38(5):553–563.CrossRefGoogle Scholar
13.Lancot, KL, Best, TS, Mittmann, N, et al.Efficacy and safety of neuroleptics in behavioural disorders associated with dementioa. J Clin Psychiatry 1998; 59(10): 550–561.CrossRefGoogle Scholar
14.Avorn, J, Monane, M, Everitt, DEet al.Clinical assessment of extra pyramidal signs in nursing home patients given anti-psychotic medication. Arch Internal Med 1994; 154: 1113–7.CrossRefGoogle Scholar
15.Lake, JT, Rahman, AH, Grossberg, GT. Diagnosis and treatment of psychotic symptoms in elderly patients. Drug and Ageing 1997 Sept; 11(3): 170–177.CrossRefGoogle ScholarPubMed
16.Beasley, CM Jr, Tollefson, GD, Tran, PV. Efficacy of olanzapine and overview of pivotal clinical trials. J Clin Psychiatry 1997; 58(suppl 10): 7–12.Google ScholarPubMed
17.De Deyn, PP, Rabheru, , Rasmussen, A, Bocksberger, JP, Dautzenberg, PL, Eriksson, S, Lawlor, BA. A randomised trial of risperidone, placebo and haloperidol for behavioural symptoms of dementia. Neurology 1999 Sept 22; 53(5): 946–55.CrossRefGoogle Scholar
18.Street, JS, Clarke, WS, Gannon, KSet al.Olanzapine treatment of psychotic and behavioural symptoms in patients with Alzheimers disease in nursing care facilities. Arch Gen Psychiatry 2000; 57: 968–976.CrossRefGoogle ScholarPubMed
19.Retz, W, Roler, M, Smitzmann, L, Becker, T. Clozapine in the treatment of neuropsych disorders in the elderly. Fortsch Neurol Psychiatr 1997; Aug 65(8): 347–53.CrossRefGoogle Scholar
20.Herrmann, N. Recommendations for the management of behaviour and psychological symptoms of dementia. J Gerantol Geriatr 1999 Jun 32(3): 153–8.Google Scholar
21.Stoppr, G, Staedt, J. Psychopharmacotherapy of behavioural disorders in patients with dementia. J Gerantol Geriatr 1999, June; 32(3): 153–8.Google Scholar
22.Doody, RS, Stevens, JC, Beck, Cet al.Practice parameter: Management of dementia(an evidence based review). Report of the quality standards. Subcommittee of the American Academy of Neurology. Neurology 2001 May 8; 56(9): 1154–66.CrossRefGoogle Scholar
23.Stoppe, G, Bandt, CA, Staedt, JM. Behaviour problems associated with dementia; the role of newer anti-psychotics. Drugs Ageing 1999 Jan; 14(1): 41–54.CrossRefGoogle Scholar