What, if not antipsychotics?

Hurray for Copperfield! I have been having this same rant every time the story of unnecessary use of antipsychotics appears on the news. As we all know, every drug comes with side-effects and risks, and it's always a balance as to whether the benefits outweigh those risks. Pamela Manners

Well said Lobley !!! This is nothing more than an attempt to save money yet social care budgets are being reduced, surely Rx levels will go up Tim Southwood

This is an evocative issue. We cannot ignore objective evidence showing lack of benefit of antipsychotics for many behavioural problems in dementia unless the patient is heavily sedated. Patients often cannot consent to the intervention. The Banerjee report suggests 20% are likely to benefit and the additional mortality is 1800 per year. Risperidone is licensed for short term usage for management of aggression/agitation though. Part of the problem may be, as alluded to by Copperfield, that use of the drugs for dementia, particularly memantine (severe disease), have not been supported by NICE. NICE now acknowledge that acetylcholinesterase inhibitors and memantine can affect behavioural symptoms. This is true for apathy, anxiety and dysphoria for acetylcholinesterase inhibitors and for agitation, aggression and irritability for memantine. I find in clinical practice this is definitely the case. We always look for precipitants of behavioural symptoms eg pain, infection, delirium. Antipsychotic use may be inevitable but I find this is mitigated by proper assessment and use of the therapeutic approaches now recommended by NICE in mild, moderate and severe dementia. This might actually incur more expense. The need for good quality care in dementia is a point well made

peter passmore

Anonymous, 20 Oct 2010
Well said Lobley !!! This is nothing more than an attempt to save money yet social care budgets are being reduced, surely Rx levels will go up Tim Southwood

Hmm, and the extra staffing (maybe desirable) will mean nursing home costs will rise ......