Reproduced from Mental Welfare Commission for Scotland, 2014.
Antipsychotic drugs are frequently prescribed with the aim of reducing symptoms of stress and distress in people with dementia. In Scotland in 2007, 17.7% of people with a diagnosis of dementia were prescribed an antipsychotic, compared to approximately 12% in 2005–2007 in one US study. Despite this high rate of use, antipsychotics have only limited benefit in treating symptoms of stress and distress in older people with dementia and carry significant risk of harm (delirium, cerebrovascular events, falls and all-cause mortality). In 2009, antipsychotics were estimated to cause approximately 1800 deaths and 1620 cerebrovascular events in people with dementia in the UK annually. However, clinical trial evidence in nursing home patients with dementia indicates that chronically prescribed antipsychotic drugs can be safely discontinued in most patients, with longer term follow-up suggesting a significant reduction in mortality.
Patients who have dementia and who have been on antipsychotics for more than 3 months and have stable symptoms should be reviewed with a view to reducing or stopping antipsychotic medication. Priority groups for reducing antipsychotic medication include:
Patients who have a co-morbid mental illness that is treated with antipsychotic medication, such as schizophrenia, persistent delusional disorder, psychotic depression or bipolar affective disorder should not have antipsychotic medication reduced without specialist advice.
A best practice guide for optimising treatment and care for behavioural and psychological symptoms of dementia is also available from Alzheimer’s Society.