Reducing Antipsychotic Prescribing for BPSD (BMJ / JAMA / JAMA Psychiatry / BJCP)


This BMJ “Change page” article discusses the potential harms associated with use of antipsychotics in people with dementia, and covers guidelines recommending restrictions in their use. Risperidone is the antipsychotic recommended for use in the treatment of aggression associated with dementia (for a maximum of 12 weeks); but only in severe cases of BPSD not responding to alternative treatment approaches.

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).


Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia. British Medical Journal (BMJ), November 3rd 2014; 349: g6420.

“The BMJ Change Page aims to alert clinicians to the need for immediate change in practice to make it consistent with current evidence”.

Citalopram for Agitation in Alzheimer’s Disease: the CitAD Trial

Possibly also of interest:

Porsteinsson, AP. Drye, LT. Pollock, BG. [et al]; CitAD Research Group (2014). Effect of citalopram on agitation in Alzheimer Disease: the CitAD randomized clinical trial. JAMA. February 19th 2014; 311(7): 682-91. Full Text Link.

Drye, LT. Ismail, Z. Porsteinsson, AP. [et al]; CitAD Research Group (2012). Citalopram for agitation in Alzheimer’s Disease: design and methods. Alzheimer’s and Dementia: the Journal of the Alzheimer’s Association. 2012; 8(2): 121-30. Full Text Link.

Antipsychotics and the Risk of Death in Patients With Dementia: Number Needed to Harm (JAMA Psychiatry)

The authors of the following article investigated the absolute change in mortality risk from antipsychotics in elderly patients with dementia, and the relative mortality risk (compared with no treatment or use of an alternative psychotropic). They report that the absolute effect of antipsychotics on mortality appears to be higher than reported previously and increases with dose. The increased risk of mortality associated with use of antipsychotics in dementia patients (in terms of numbers of patients needed to harm over 180 days follow-up) ranged from 50 (quetiapine) to 26 (haloperidol).

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).


Maust, DT. Kim, HM. [and] Seyfried, LS. [et al] (2015). Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry, March 18th 2015. [Epub ahead of print]. (Click here to view the PubMed abstract).

Adverse Drug Reactions in the Elderly (British Journal of Clinical Pharmacology)

Medication reviews can reduce the risk falls in community dwelling elderly. The majority of adverse drug reactions (ADRs) in older people are potentially avoidable and linked to commonly prescribed drugs. Several ADRs (such as those arising from antipsychotics) are linked to major adverse consequences.

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).


Davies, EA. [and] O’Mahony, MS. (2015). Adverse drug reactions in special populations – the elderly. British Journal of Clinical Pharmacology. May 22nd 2015. [Epub ahead of print].

About Dementia and Elderly Care News

Dementia and Elderly Care News. Wolverhampton Medical Institute: WMI. (jh)
This entry was posted in Acute Hospitals, Antipsychotics, Community Care, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), International, Management of Condition, Mental Health, Models of Dementia Care, Non-Pharmacological Treatments, Person-Centred Care, Pharmacological Treatments, Practical Advice, Quick Insights, Standards, Statistics, UK and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

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