PB RCPsych Publications
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals
QUICK SEARCH:   [advanced]


     

Psychiatric Bulletin (2007) 31: 357-358. doi: 10.1192/pb.31.9.357b
© 2007 The Royal College of Psychiatrists
This Article
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by MacEwan, T.
Right arrow Articles by Murray, G.
Right arrow Search for Related Content
PubMed
Right arrow Articles by MacEwan, T.
Right arrow Articles by Murray, G.

Correspondence

Audit of antipsychotic prescribing in dementia

Tom MacEwan, Consultant Old Age Psychiatrist

Royal Cornhill Hospital, Aberdeen AB25 2ZH, Scotland, email: tom.macewan{at}gpct.grampian.scot.nhs.uk

Elizabeth Turner, Final Year Medical Student

University of Aberdeen

Gillian Murray, Community Psychiatric Nurse

Royal Cornhill Hospital, Aberdeen

Soyinka & Lawley (Psychiatric Bulletin, May 2007, 31, 176-178) report an audit of a crucial treatment in dementia. The finding that 54% of patients received an antipsychotic accords with an audit we conducted in which 49% of patients with behavioural and psychological symptoms of dementia received such treatment. These patients were living in care homes and were referred by general practitioners. We disagree that this represents a ‘concerning trend of "medicalising"’ such symptoms. These patients are probably at the severe end of a spectrum so it is not surprising that many require antipsychotics. We feel that many patients do benefit from these drugs. Even CATIE-AD (Schneider et al, 2006) report effectiveness of antipsychotics but suggest restriction to patients with minimal side-effects and where benefit is observed.

We disagree with the assumption that findings can be generalised across the country; 50% of patients in the report received typical antipsychotics compared with only 12% in our audit. We note that the National Institute for Health and Clinical Excellence does not distinguish between antipsychotic subtypes (National Institute for Health and Clinical Excellence, 2006) and we wonder if this reflects the growing realisation, referred to by Soyinka & Lawley, that cerebrovascular risk might be shared by all antipsychotics, not just the atypicals.

We have a designated community psychiatric nursing service for care homes, which improves quality of care with targeted antipsychotic use and prompt follow-up and liaison. All patients in our audit had a clear indication for treatment and 94% were reviewed within 3 months. We should use antipsychotic drugs when required to alleviate patient suffering and agree that documented review of patients on antipsychotic drugs is important.

References

SCHNEIDER, L. S., TARIOT, P. N., DAGERMAN, K. S., et al (2006) Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. New England Journal of Medicine, 355, 1525 -1538.[Abstract/Free Full Text]

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE (2006) Dementia. Supporting People with Dementia and Their Carers in Health and Social Care. NICE. http://www.nice.org.uk/CG042





This Article
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by MacEwan, T.
Right arrow Articles by Murray, G.
Right arrow Search for Related Content
PubMed
Right arrow Articles by MacEwan, T.
Right arrow Articles by Murray, G.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals