Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Pharmaceutical care

Antipsychotic drug guidelines for patients with dementia need to be reviewed

Used on its own, review protocol that reduces antipsychotic drugs in people with dementia could worsen symptoms, study finds.

Guidelines for reviewing the use of antipsychotic drugs to control neuropsychiatric symptoms, such as aggression, agitation and psychosis, in patients with dementia need urgent review, say researchers. In the image, a nurse helps an elderly person

Source: Paula Solloway / Alamy Stock Photo

Worsening neuropsychiatric symptoms can be highly distressing, say researchers who looked at the impact on patients of different approaches to reducing antipsychotic drug use in nursing homes

Guidelines for reviewing the use of antipsychotic drugs to control neuropsychiatric symptoms – such as aggression, agitation and psychosis – in patients with dementia need urgent review, say researchers.

The study, published in The American Journal of Psychiatry[1] on 20 November 2015, looked at the impact on patients of different approaches to reducing antipsychotic drug use in nursing homes.

Researchers found that a review protocol, based on National Institute for Health and Care Excellence (NICE) guidelines, reduced the use of antipsychotic drugs by dementia patients but led to deterioration of neuropsychiatric symptoms. However, when the protocol was used alongside a programme of social interaction and activities, neuropsychiatric symptoms and mortality rates improved.

“Reducing the use of these drugs without any other interventions could result in worsening of neuropsychiatric symptoms, which are highly distressing to the person, their carers and loved ones,” says Anne Corbett, one of the researchers. The results demonstrate the “critical importance” of ensuring that any reduction in medication is accompanied by non-drug approaches to symptom control, particularly social interaction, she adds.

The trial involved 277 patients with dementia living at 16 nursing homes in London, Oxfordshire and Buckinghamshire. The researchers from the Institute of Psychiatry, Psychology & Neuroscience at King’s College London randomly assigned each nursing home to deliver one or more of a combination of three interventions — antipsychotic review, social interaction and an exercise programme — over nine months.

The review protocol reduced antipsychotic drug use by 50% but there was an increase in neuropsychiatric symptoms when used alone (score difference +7.37, 95% confidence interval [CI] 1.53–13.22).

Patients who received the social interaction intervention in addition to the review experienced reduced neuropsychiatric symptoms of -0.44 (95% CI -4.39–3.52) and significantly reduced mortality (odds ratio 0.26, 95% CI 0.13–0.51) compared with the group receiving neither. The social interaction intervention involved at least three planned social interactions per week, delivered via individual or group sessions, to enhance residents’ interactions with staff, family or volunteers.

The exercise programme, which was personalised and involved a 20% increase in exercise activity for at least one hour per week, reduced neuropsychiatric symptoms (score difference -3.59, 95% CI -7.08 to -0.09) but did not improve depression (score difference -1.21, 95% CI -4.35 to -1.93).

“These findings should prompt an urgent review of guidelines for the use of antipsychotic drugs, to ensure that review of these medicines are in the best interests of people with dementia,” Corbett concludes.

The antipsychotic review intervention, based on the NICE dementia guideline published in 2006 and antipsychotics guidance developed by the Alzheimer’s Society, involved regular scrutiny of prescriptions and targeted education for doctors and nurses.

While antipsychotics can be used to control neuropsychiatric symptoms for short periods, their long-term use needs to be carefully monitored as it may result in an increased risk of cognitive decline, stroke and death.

Doug Brown, director of research at the Alzheimer’s Society, says the research sheds light on the need for care to be based on rigorous scientific evidence. “Although it is important to reduce inappropriate antipsychotic use in care homes, other programmes, for example encouraging social interaction, are needed alongside this in order to reduce some of the behavioural symptoms of dementia,” he says. “Further research is needed to fully understand how to provide the very best care for people affected by dementia and to create guidelines to aid care providers in their roles.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20200152

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Drugs of Abuse

    Drugs of Abuse

    A concise, easy-to-read guide for healthcare professionals who encounter drug abuse.

    £38.00Buy now
  • Pharmaceutical Toxicology

    Pharmaceutical Toxicology

    Explains the methodology and requirements of pre-clinical safety assessments of new medicines. Includes registration requirements and pharmacovigilance.

    £40.00Buy now
  • Sport and Exercise Medicine for Pharmacists

    Sport and Exercise Medicine for Pharmacists

    All the information you need to provide patients with evidence-based advice on sports and exercise related health matters.

    £27.00Buy now
  • Adverse Drug Reactions

    Adverse Drug Reactions

    A practical guide to the drug reactions that affect particular organ systems, and the management of these reactions.

    £38.00Buy now
  • English Delftware Drug Jars

    English Delftware Drug Jars

    This beautiful book illustrates the art and history of the collection of English delftware drug jars in the Museum of the Royal Pharmaceutical Society of Great Britain.

    £54.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Supplementary images

  • Guidelines for reviewing the use of antipsychotic drugs to control neuropsychiatric symptoms, such as aggression, agitation and psychosis, in patients with dementia need urgent review, say researchers. In the image, a nurse helps an elderly person

Jobs you might like

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.