Opinions vary as to whether provision of spiritual care should become widely available to older people with mental health needs who are admitted to hospital. Old age psychiatrists recognize that awareness of spiritual dimensions may be important for their patients. They seem less clear about the role of spiritual advisors and how NHS multidisciplinary clinical teams and spiritual and pastoral care services can be best integrated. Much work needs to be done on developing effective training and operational policies in this area.

No abstract

Aims and MethodTo compare current prescribing practice for psychotic and behavioural symptoms in dementia with the available research. An anonymous questionnaire was sent to all members of the Faculty of Old Age Psychiatry, enquiring about preferred drug treatments.ResultsClassical antipsychotics were chosen by 50% for psychotic symptoms over atypical antipsychotics (43%) and were preferred for aggression (48%) and sexual disinhibition (55%). Antidepressants were favoured in treating anxiety (41%) and lability (45%).Clinical ImplicationsAlternatives to classical antipsychotics, especially for behavioural symptoms, have yet to be researched satisfactorily. In view of the continued widespread use of classical antipsychotics and recent concerns about their safety, we call for this to be addressed.

AIMS AND METHODThere is increasing evidence-based knowledge in the drug treatment of psychotic and behavioural symptoms in dementia, but drugs do not possess a formal licence for these indications. Drug companies, health authorities, NHS trusts and medical defence unions were asked for their advice on the medico-legal implications for the prescribing clinician.RESULTSDrug companies, health authorities, medical defence unions and NHS trusts are aware of out-of-licence prescribing and leave ultimate accountability with the clinician. A suggested best practice is that of obtaining the patient's consent.CLINICAL IMPLICATIONSOut-of-licence prescribing for psychotic and behavioural symptoms in dementia is widespread. This patient group may be unable to grant consent. The accountability of individual clinicians should be supported by more adequate medico-legal frameworks.