Journals Club - Antipsychotic prescribing for patients with dementia

Dr Louise Newson brings us up to date with the latest research and guidance on prescribing for dementia.

MRI of patient with dementia
MRI of patient with dementia

Curriculum statement 9: Care of older adults

Key trials

  • Adverse effects for atypical antipsychotics in dementia patients have emerged in recent years. There is a threefold increase in risk of stroke with atypical drugs and mortality risk is raised for both typical and atypical antipsychotics (Lancet Neurol 2009; 8: 125).
  • One study found that among elderly patients, the risk of death associated with conventional antipsychotic medications is comparable with, and possibly greater than, the risk of death associated with atypical antipsychotic medications (CMAJ 2007; 176: 627-32).
  • The DART-AD trial was the first long-term follow-up study to show that patients with Alzheimer's disease on antipsychotic drugs are at increased risk of mortality. Patients who received antipsychotic treatment for 12 months were more likely to have died by the 24-month and 36-month follow-up than patients who received placebo (Lancet Neurol 2009; 8: 151-7).

Evidence base

  • In view of the cerebrovascular adverse events and death associated with antipsychotic use in dementia patients, one article has highlighted the studies examining the risks and benefits of antipsychotic drugs. The authors conclude that weighing small but significant risks compared with benefits is a complex decision (J Psychosoc Nurs Ment Health Serv 2008; 46 : 19-23).

Guidelines

  • NICE guidance advises that clinicians should avoid using any antipsychotics for non-cognitive symptoms or challenging behaviour of dementia unless the patient is distressed or there is an immediate risk of harm to them or others. Any use of antipsychotics should include a full discussion with the patient and/or carers (NICE. Dementia. CG42. London, NICE 2006).

Contributed by Dr Louise Newson, a GP in the West Midlands.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

A day in the life of a prison GP

A day in the life of a prison GP

Dr Patrick Staite tells GP Jobs what it is like to work as a prison GP.

GP practice list size up nearly 50% since 2004 contract

GP practice list size up nearly 50% since 2004 contract

The average GP practice list in England has increased by almost half since the new...

Fresh calls to scrap Capita contract as more cervical screening failures emerge

Fresh calls to scrap Capita contract as more cervical screening failures emerge

The BMA has renewed calls for NHS England to strip Capita of its primary care support...

Cost-effectiveness of GP at Hand 'challenging' to assess, interim report warns

Cost-effectiveness of GP at Hand 'challenging' to assess, interim report warns

The cost-effectiveness of the Babylon GP at Hand service will be difficult to determine...

How we improved end-of-life care in our practice

How we improved end-of-life care in our practice

Dr Victoria Middleton explains how her practice has increased the number of patients...

12,000-patient practice forced to close after service charge hike

12,000-patient practice forced to close after service charge hike

A 12,000-patient GP practice in Nottinghamshire has been forced to hand back its...