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GPs need support in taking more dementia patients off antipsychotics, say experts

Experts are calling for updated guidance to help GPs stop prescribing antipsychotic medications in more patients with dementia, alongside a call for more interventions based on social interactions.

The team said that while antipsychotic prescriptions have been cut drastically in nursing homes in recent years, still more patients could benefit from coming off the drugs – provided they received a simple intervention to boost their social interactions.

The experts, led by Professor Clive Ballard, professor of age-related diseases at the Institute of Psychiatry, Kings College London, carried out a study in which patients had their antipsychotic medications reviewed regularly, with or without a simple intervention that included one hour a week of pleasurable activities based around social interaction.

Professor Ballard told Pulse that simply carrying out antipsychotic review enabled half of patients to come off the drugs – but that they experienced worsening of neuropsychiatric symptoms and quality of life.

By contrast, the group that also received the social interaction had improved quality of life – and a ‘staggering’ 36% reduction in mortality when compared with patients kept on medication.

Professor Ballard said the proportion of dementia patients on antipsychotics has fallen markedly from around 50% to 20% since GPs were encouraged to take patients off the drugs as part of the Prime Minister’s Challenge on dementia.

As a result, most patients who are still currently taking antipsychotic medications are those with ‘more severe neuropsychiatric symptoms who require more careful clinical decision on whether or not to stop the medications as the effect on quality of life can go either way’, he explained.

Professor Ballard said: ‘We need a slight change to current government policy, which isn’t “reduce, reduce, reduce” when possible, it’s careful review, reduce when possible, but you need to be able to implement these other things as part of doing that.’

The findings of the study are published in the American Journal of Psychiatry.

Am J Psych 2015; available online 20 November


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