Antipsychotic drugs

90% of people with dementia experience behavioural and psychological symptoms (BPSD), such as aggression, agitation, loss of inhibitions and psychosis (delusions and hallucinations). These symptoms can be distressing for the person and their carers as well as putting the person at risk.

People with dementia who experience BPSD are often, and inappropriately, prescribed antipsychotic drugs used to treat schizophrenia. Antipsychotic drugs do reduce psychotic experiences such as delusion. However, they are also linked to serious side effects, have a moderate benefit and do not address underlying causes of BPSD. A Department of Health study concluded of the 180,000 prescriptions for people with dementia overall, 140,000 are inappropriate.

Inappropriate prescription of antipsychotic drugs is extremely harmful. Research has shown that there is up to a 9-fold risk of stroke in the first four weeks (Klijer, 2009) and that there is almost a doubling in the risk of mortality (Food and Drug Administration, 2005). Inappropriate prescription of antipsychotic drugs contributes to 1,800 deaths a year death (DH, 2009a).

Reducing the use of antipsychotic drugs for people with dementia is a national priority in England (DH, 2009a) and is a key element identified in the Dementia Plans for Wales (Welsh Assembly Government, 2010). An audit of antipsychotic prescriptions for people with dementia (NHS Information Centre, 2012) has revealed that antipsychotic prescriptions for people with dementia have reduced by 52 per cent between 2008 and 2011. However, it also revealed strong regional variations in the number of prescriptions.

There must now be continuing action at a local level in England, and urgent action in Wales and Northern Ireland to improve treatment and care in order to reduce the use of the drugs. The point must be reached where antipsychotic drugs are only prescribed to people with dementia when necessary and appropriate.