Medico-legal implications of drug treatment in dementia: prescribing out of licence

Lawrence, Robert M.; Scott, Katherine A.; Duggal, Anita; Darwin, Cressida; Brooks, Elizabeth; Christodoulou, Georgina

doi:10.1192/pb.26.6.230

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…'Out-of-licence' prescribing of atypical antipsychotics for control of behavioural and psychotic symptoms in dementia is said to be widespread and understandable, given the research findings that point increasingly to their efficacy (Lawrence et al, 2002). The importance of gaining patient or substitute consent has been highlighted.…”

Section: Introductionmentioning

confidence: 98%

Why and how antipsychotic drugs are used in 40 Sydney nursing homes

Snowdon

Day

2005

Int. J. Geriat. Psychiatry

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Section: Introductionmentioning

confidence: 98%

Why and how antipsychotic drugs are used in 40 Sydney nursing homes

Snowdon

Day

2005

Int. J. Geriat. Psychiatry

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“…In an attempt to reduce these symptoms and prevent their possible negative consequences, pharmacological treatments are normally considered the first treatment option without considering other alternative non-pharmacological therapies. However, it has been well-documented how this pharmacological treatment as a first-line option has led to a significant over-/misuse of psychiatric drugs (Lawrence et al, 2002) during the last decades. Therefore, by employing SR as a behavioral modification technique, patients have the possibility to learn a large variety of basic ADLs such as how to eat adequately, decreasing thus related-eating problems and potential risks (Shinagawa et al, 2016).…”

Section: Clinical Applicationsmentioning

confidence: 99%

Spaced Retrieval Effects on Learning Capacity in Patients With Mild-to-Moderate Cognitive Impairment

de la Rosa Gámiz,

González-Moreno,

Cantero-García

2023

European Psychologist

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Spaced retrieval (SR) improves the learning capacity of patients with memory deficits, while evidence on its long-term and generalization to other untrained measures is quite inconsistent. This systematic review was to analyze evidence on the SR effectiveness on recall performance, follow-up, and generalization measures in patients with cognitive impairment. A systematic search on PUBMED, MEDLINE, Web of Science, PubPsych, and ProQuest was performed between November 2020 and January 2021. The benefit effect of SR on direct, generalization, and long-term measures did not significantly differ from other learning techniques and the effect sizes even increased when SR was combined with another method. Effects on generalization depended on the similarity between the trained and untrained material. Existing evidence on SR remains quite scarce, mainly based on studies with moderate methodological quality giving rise to very heterogeneous results. Further investigation is still needed to overcome previous methodological limits and extend evidence to the immediate and long-term effects of the simultaneous application of different learning methods.

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Use and misuse of antipsychotic drugs in patients with dementia in Alzheimer special care units

Nobili¹,

Pasina²,

Trevisan

et al. 2009

International Clinical Psychopharmacology

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The objective of this study was to estimate the prevalence of antipsychotic use and investigate their association with behavioural and psychological symptoms of dementia (BPSD) and other clinical predictors. Patients with dementia, aged 65 and above and resident in 35 Alzheimer special care units were sequentially enrolled into a 18-month prospective observational study. Data on sociodemographic, cognitive, functional, behavioural and clinical characteristics and drug exposure were collected at baseline and at 6-month intervals up to 18 months. The prevalence of antipsychotic use and the association with BPSD and clinical predictors were analysed. Of the 349 patients with dementia enrolled in the study, 209 (60%) were taking at least one antipsychotic. Risperidone and promazine were the most frequently prescribed antipsychotic; 40.7% simultaneously received a benzodiazepine, 20% an antidepressant. More than 50% were still taking antipsychotics at 18 months of follow-up. No associations were found between antipsychotic use and level of cognitive impairment, basal activity of daily living disability and comorbidity. Multivariate analysis showed that the use of antipsychotics was highest in patients in the highest quartiles of Neuropsychiatric Inventory Scale score (III quartile, odds ratio: 1.63; 95% confidence interval: 1.19-2.23; IV quartile, odds ratio: 2.27; 95% confidence interval: 1.61-3.26). This study found high rate of use of antipsychotics in patients with dementia resident in Alzheimer special care units, frequent associations with other psychotropic medications and a strong correlation with BPSD.

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Medico-legal implications of drug treatment in dementia: prescribing out of licence

Cited by 4 publications

References 11 publications

Why and how antipsychotic drugs are used in 40 Sydney nursing homes

Why and how antipsychotic drugs are used in 40 Sydney nursing homes

Spaced Retrieval Effects on Learning Capacity in Patients With Mild-to-Moderate Cognitive Impairment

Use and misuse of antipsychotic drugs in patients with dementia in Alzheimer special care units

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