Identifying fallacious arguments in a qualitative study of antipsychotic prescribing in dementia

Abstract

Fallacious arguments were often formulated to present convincing cases whereby prescribing antipsychotics or maintaining existing doses (versus not starting medication or reducing the dose, for example) appeared as the only acceptable decision but this is not always the case. The findings could help health professionals to recognise and mitigate the effect of logic-based errors in decisions about the prescribing of antipsychotics in dementia.

General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

“…To ensure credibility and dependability of coding, a second reviewer (K.W.) also coded 3 studies . Conceptual groupings were created for each study and illustrated with conceptual mind maps.…”

“…In 4 studies, the prescribing of antipsychotics was seen to enable carers, nursing home staff, and the person with dementia to cope with BPSD: “ he was weeping for his wife who has been dead for many years … on quetiapine … the uncontrollable weeping had stopped. ” Although in some studies GPs were aware of the risks of antipsychotic prescribing in people with dementia, these risks were seen to relate to longevity of life whereas in BPSD “quality of life issues prevailed.” In several studies, GPs' believed antipsychotics positively impacted on the quality of life of people with BPSD . This contributed to their reluctance to discontinue antipsychotics .…”

“…” Although in some studies GPs were aware of the risks of antipsychotic prescribing in people with dementia, these risks were seen to relate to longevity of life whereas in BPSD “quality of life issues prevailed.” In several studies, GPs' believed antipsychotics positively impacted on the quality of life of people with BPSD . This contributed to their reluctance to discontinue antipsychotics . Additionally, in 2 studies, GPs expressed a concern that discontinuing the antipsychotic would lead to a “return of challenging behaviours.”…”

“…Earlier studies described how antipsychotics “may be the best available option for physicians.” However, as the evidence for the harmful effects of using antipsychotic medications in people with dementia emerged, there has been a distinct shift. The use of antipsychotics became less acceptable: “antipsychotics should not be prescribed to reduce stress in carers …” The studies in this review highlight the journey the management of BPSD has travelled over the past 2 decades—from “what is the right psychotropic to use?” to “should we be using psychotropic medication?” to “stop using psychotropic medication.” A parallel journey occurred for non‐pharmacological management strategies, which received increased emphasis.…”

“…also coded 3 studies. [44][45][46] Conceptual groupings were created for each study and illustrated with conceptual mind maps. The 2 reviewers involved (A.J.…”