Ethical dilemmas: should antipsychotics ever be prescribed for people with dementia?

Treloar, Adrian; Crugel, Monica; Prasanna, Aparna; Solomons, Luke; Fox, Chris; Paton, Carol

doi:10.1192/bjp.bp.109.076307

Cited by 29 publications

(21 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prescribing a medication that increases mortality risk seems contrary to the tenet “first, do no harm,” yet for patients who pose a danger to themselves and others and are in profound distress, use of such medications may still be appropriate. 31,32 These new data can help physicians minimize the potential harm associated with antipsychotic treatment.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia

et al. 2015

View full text Add to dashboard Cite

IMPORTANCE Antipsychotic medications are associated with increased mortality in older adults with dementia, yet their absolute effect on risk relative to no treatment or an alternative psychotropic is unclear.OBJECTIVE To determine the absolute mortality risk increase and number needed to harm (NNH) (ie, number of patients who receive treatment that would be associated with 1 death) of antipsychotic, valproic acid and its derivatives, and antidepressant use in patients with dementia relative to either no treatment or antidepressant treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Reports have highlighted distress as an important indication for treatment. 19 Our survey revealed appropriate motivations for initiating antipsychotics in the great majority of cases: patients' distress and agitation (70%), aggressive behaviours and psychotic symptoms (44%), with high co-occurrence of multiple symptoms and behaviours. The view that antipsychotics are used primarily to manage resistive behaviours and wandering was not substantiated in our sample.…”

Section: Discussionmentioning

confidence: 86%

“…It is true that the risks associated with antipsychotic drugs must inform our decisions, but so must benefits. There is a place for antipsychotics in the treatment of severe and distressing symptoms of dementia 1,2,19,24 and declining treatment to that subpopulation could cause more harm than good. To illustrate, in the past few years, concerns have been raised that the reduction in antidepressant prescriptions for adolescents following safety warnings by the US Food and Drug Administration (FDA), the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMEA) was followed by an increase in the number of suicides.…”

Section: Crugel Et Al Antipsychotics In Dementiamentioning

confidence: 99%

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

et al. 2012

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…An alternative view is that, since we know these drugs can work, then (despite the risks) they should be used carefully, especially if our aim is to palliate: "Severe distress should be appropriately palliated using the best and most effective medicines with the overriding goal of reducing suffering. … If old-age psychiatry services move more clearly towards a palliative model as dementia progresses, they may become more able to justify the use of antipsychotic drugs for the express purpose of reducing suffering" [37].…”

Section: Other Medicationsmentioning

confidence: 99%

The Challenges of Providing Palliative Care for Older People with Dementia

Küpper

Hughes

2011

Curr Oncol Rep

View full text Add to dashboard Cite

Palliative care seems the right approach to dementia, except that it suggests a dichotomy between cure and care. As in cancer care, supportive care provides a broader framework, viewing dementia from the time of diagnosis until death and bereavement. The challenge is to find the right approach to the individual. This challenge arises in the person's own home, in long-term care homes, and in hospitals. The challenging features of palliative care for older people with dementia are found in connection with the use of antibiotics, antipsychotics, and other medications, as well as in decisions about whether the person is in pain or in distress, or whether artificial feeding should be contemplated or not, as well as about the use of advance care plans. In short, the challenges are essentially ethical as well as clinical. The right approach will be the one that recognizes this facet of clinical care.

show abstract

Ethical dilemmas: should antipsychotics ever be prescribed for people with dementia?

Cited by 29 publications

References 6 publications

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia

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

The Challenges of Providing Palliative Care for Older People with Dementia

Contact Info

Product

Resources

About