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Authors' reply

Published online by Cambridge University Press:  02 January 2018

Adrian J. Treloar
Affiliation:
Oxleas NHS Foundation Trust, Memorial Hospital, Shooters Hill, London SE18 3RG, UK. Email: [email protected]
Carol Paton
Affiliation:
Oxleas NHS Foundation Trust, Imperial College, London, and the Prescribing Observatory for Mental Health
Monica Crugel
Affiliation:
Oxleas NHS Foundation Trust, London
Luke Solomons
Affiliation:
South London and Maudsley NHS Foundation Trust
Aparna Prasanna
Affiliation:
Hospital of St Cross, Coventry and Warwickshire Partnership NHS Trust, Rugby
Chris Fox
Affiliation:
Kent and Medway NHS & Social Care Partnership Trust, UK
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Abstract

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Columns
Copyright
Copyright © Royal College of Psychiatrists, 2010 

We are pleased to see support for our views in the responses received, in particular for the focus on rational debate in this area, rather than an ‘either/or’ debate. However, we would in reply air the following cautions.

Pattanayak claims that antipsychotics may not be as harmful as we have been led to believe. We would urge caution here. The data produced so far do suggest a reliable and quantifiable degree of harm resulting from antipsychotic use. We do not think that it is truly reasonable, now, to suggest that these drugs may be harmless. But we would also argue that Pattanayak's desire to claim a lack of harm is unnecessary. If they are harmful, their use may be justified under the doctrine of double effect by balancing the likely benefits against harm. It is our clinical experience that the discussions of benefit versus harm with relatives and advocates, informed by the principal of double effect, are effective and well understood.

Finally, we note what is, perhaps, an important slip of the pen in Sekhri's letter. He uses the term non-pharmacological as shorthand for alternatives to antipsychotics. He is correct in saying that there are multiple causes of behavioural and psychological symptoms of dementia. But if we describe all alternatives to antipsychotics as non-pharmacological, we may forget the appropriate treatment of physical illness with analgesics or depression with antidepressants. Alternatives to antipsychotic use in distress include both pharmacological and non-pharmacological approaches. One of us remembers replacing haloperidol for behavioural and psychological symptoms of dementia with effective treatment for scabies. Aromatherapy would have done little here! The term ‘non-pharmacological’ may therefore distract clinicians and compound a paucity of response to a complex problem.

References

Edited by Kiriakos Xenitidis and Colin Campbell

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