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Dilemma over antipsychotic use in dementia

Published online by Cambridge University Press:  02 January 2018

Rajesh Sekhri*
Affiliation:
Garnock Day Centre, Ayrshire Central Hospital, Irvine KA12 8SS, UK. Email: [email protected]
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Abstract

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Columns
Copyright
Copyright © Royal College of Psychiatrists, 2010 

I agree with the views expressed by Treloar et al Reference Treloar, Crugel, Prasanna, Solomons, Fox and Paton1 regarding antipsychotic use in dementia. This is not only an ethical dilemma, but an issue of medical prescribing practice that has entered public and political domains. The present widespread use of antipsychotics seems to be unjustified but the emphasis should be on more rational use of these medications rather than an either/or debate. Our focus should be to develop policies and protocols which can lead to justified use of antipsychotics, with continuing reviews of the need for these medications. Their editorial is a step in right direction.

It seems that antipsychotic use in dementia is being demonised in the media. Reference Hope2Reference Triggle4 Policy makers are also pushing for a decrease in their use. I have two issues with the direction this debate is taking us. First, I hope the pendulum does not swing so far in the other direction, that psychiatrists find it hard to prescribe the medication even to those who will benefit from its use. Reference Brummel-Smith5 Second, although the main push seems to be towards reduction of antipsychotic use, less is said on how to develop the resources that can provide good non-pharmacological approaches. Audits and targets should not solely focus on the quantity of antipsychotic use in dementia but also on the quality of non-pharmacological approaches available to this population. Long strides are required in this direction to improve behavioural and psychological symptoms of dementia care in the community, hospitals and care homes.

Footnotes

Edited by Kiriakos Xenitidis and Colin Campbell

References

1 Treloar, A, Crugel, M, Prasanna, A, Solomons, L, Fox, C, Paton, C, et al. Ethical dilemmas: should antipsychotics ever be prescribed for people with dementia? Br J Psychiatry 2010; 197: 8890.Google Scholar
2 Hope, J. More than 100,000 dementia patients are given anti-psychotic drugs that ‘may kill’. Mail Online 2008; 28 April.Google Scholar
3 Laurance, J. ‘Liquid cosh’ treatment kills dementia patients. The Independent 2009; 9 January.Google Scholar
4 Triggle, N. Dementia drug use ‘killing many’. BBC News 2009; 12 November.Google Scholar
5 Brummel-Smith, K. It's time to require written informed consent when using antipsychotics in dementia. Br J Med Pract 2008; 1: 46.Google Scholar
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