Antipsychotics in people with dementia: frequency of use and rationale for prescribing in a UK mental health service

Abstract

Aims and methodTo determine how often and why antipsychotic medicines are prescribed to people with dementia. A cross-sectional survey of all clinical records was conducted in one National Health Service mental health trust.ResultsOf 946 people with dementia in the trust, 186 (20%) were prescribed an antipsychotic. Prevalence increased with the severity of dementia. The most common indication for initiating treatment was agitation/distress (70%), followed by verbal aggression (45%), psychotic symptoms (44%) and physical aggression (33%). The mean number of indications per patient was 2.6. In 58% of cases, the antipsychotic had been prescribed for more than a year, and a third of patients had not been reviewed in the past 6 months.Clinical implicationsPeople with dementia who are prescribed antipsychotic drugs generally display a range of challenging behaviours, but most notably are distressed. Systems for ongoing clinical review need improvement.

Dementia ascertainment using existing data in UK longitudinal and cohort studies: a systematic review of methodology

“… Yes 14 Cook et al [ 37 ] Incidence of stroke and seizure in AD Cohort Full THIN e Read codes for AD. No 9 Crugel et al [ 7 ] Antipsychotic use in dementia Cohort Part Electronic clinical records for trust (Rio) Confirmed ICD-10 diagnosis of dementia. No 7 Doll et al [ 42 ] Smoking and dementia Outcome Full Death certificates Dementia ‘mentioned’ on death certificate.…”

“…Where only one sub-study met the inclusion criteria for this review, the results listed considered only the eligible sub-study. Overall, the quality scores ranged from 7/16 [ 7 , 8 ] to 16/16 [ 9 , 10 ] and the mean score achieved across all 47 papers was 12.0 (SD: 2.6). Quality scores were lower for studies using existing data alone for ascertainment ( n = 36; mean = 11.5 (SD 2.6)), compared with studies using existing data in addition to other methodologies ( n = 11; mean 13.4 (SD 2.3)) ( p < 0.05).…”

“…If the proportion of probable dementia in missing records was the same as for the available records, 12% of cases would have been missed as a result [ 22 ]. Crugel et al [ 7 ] did not perform any validation study but did note that it was known that the number of dementia cases identified using their electronic record system was lower than the number known to the hospital trust. Renvoize et al [ 23 ], who used local computerised medical and social records for case identification, found a prevalence rate consistent with previous studies.…”

“…The articles included in the final analysis covered a wide variety of specific study topics. The results of the quality measure varied widely, but those papers demonstrating the poorest scores for quality of description were, in nearly all cases, papers in which dementia ascertainment was performed in order to build a cohort for further study [ 7 , 8 , 19 , 32 – 34 ]. This might be expected given that dementia ascertainment was not the focus of these studies and thus the descriptions of method concentrated on other aspects of the studies.…”

Associations between risk of mortality and atypical antipsychotic use in vascular dementia: a clinical cohort study

“…The clinical documentation within CRIS was written as part of routine clinical practice rather than for research purposes. Although other atypical antipsychotics and the typical antipsychotic haloperidol were not included in this study, UK audit data indicates that prescription rates of these alternative antipsychotic medications account for only 6% of prescriptions indicating that by including risperidone, olanzapine and quetiapine, this study represents the vast majority of antipsychotic prescribing (Crugel et al, 2012). Finally, by their nature, cohort studies are open to residual confounding, such as indication bias, subject selection bias and information bias (Trifiro et al, 2007).…”