[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 3 Issue 2, September 2012].
It is estimated that up to a quarter of people in the UK with a diagnosis of dementia are prescribed antipsychotics each year. This study examined the prevalence and quality of antipsychotic use for dementia in secondary mental health services in the UK. Given the concerns about inappropriate prescribing of these drugs, data relevant to quality improvement initiatives for prescribing practice was collected.
Fifty-four mental health NHS trusts submitted data on 10,199 patients with dementia under the care of specialist older people’s mental health services. 1620 (16%) of these patients (without comorbid psychotic illness) were prescribed an antipsychotic. Of the 1001 (62%) patients prescribed treatment for longer than 6 months, only three-quarters had a documented review of therapeutic response in the previous 6 months.
Common clinical indications for antipsychotics are agitation, psychotic symptoms, aggression and distress, according to this study. Younger age, care home or in-patient settings, vascular dementia or Parkinson’s disease dementia and greater severity of dementia are associated significantly with higher probability of being prescribed antipsychotic medication.
The researchers recognise “areas of relatively good current practice, including consideration of alternatives to antipsychotic medication and clear documentation of target symptoms”. They suggest areas for improvements, including the frequency and quality of reviews of long-term antipsychotic medication. Strategies to reduce antipsychotic use should take account of the demographic and clinical factors associated with an increased likelihood of antipsychotic prescription (see above).
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Barnes, TR. Banerjee, S. [and] Collins, N. [et al] (2012). Antipsychotics in dementia: prevalence and quality of antipsychotic drug prescribing in UK mental health services. British Journal of Psychiatry: the Journal of Mental Science, July 12th 2012. [Epub ahead of print]. (Click here to view the PubMed abstract).