4. Antipsychotic medication
New information is shedding light on how antipsychotics prescribing needs to change.
People with dementia may develop behavioural and psychological symptoms, including restlessness, aggression, delusions, hallucinations, depression and anxiety. These symptoms become more common as the disease progresses. They can be caused by an unmet need – for example, hunger, thirst or discomfort – or a health problem such as an infection.
People with these symptoms are often prescribed antipsychotic drugs inappropriately. These may reduce experiences such as delusions, but they are also linked to serious side effects including increased risk of stroke and even death. After an initiative to reduce the prescribing of antipsychotics in England, an audit of GP practices in 2012 found that prescriptions had reduced by half between 2008 and 2011.
However, a recent study led by Professor Ala Szczepura at Coventry University suggested that prescriptions may not have decreased in the way we believed they had. The study examined prescribing in 600 care homes and found no decrease in prescription rates between 2009 and 2012. They also reported that antipsychotic drugs were often given for much longer than the recommended six weeks.
George McNamara, Head of Policy at Alzheimer’s Society, said, ‘This continued reliance on antipsychotics to manage behavioural symptoms of dementia is deeply worrying. With person-centred approaches and training programmes for care home staff, continued inappropriate prescribing is a step backward into the dark ages.’
Importantly, the risks of antipsychotic drugs aren’t the same for all people with dementia. Another recent study analysed data from six trials of an antipsychotic called risperidone, involving a total of 1,723 patients.
The study, led by Professor Rob Howard and Dr Sergi Costafreda at Camden and Islington NHS Foundation Trust, found that patients who were experiencing delusions when the treatment started didn’t have a significantly higher risk of stroke. This may help to improve guidance about when medication is or is not appropriate.