Facts you need to know about anti-psychotic drugs and dementia

12/12/2007

The use of anti-psychotic drugs has been highlighted recently by the expose on BBC's Panorama, which raised concerns after showing how many people are kept in a state of continuous sedation. Professor Clive Ballard, Director of Research at the Alzheimer's Society and a leading old-age psychiatrist at Kings College London, answers the most common questions about the use of anti-psychotic drugs in the treatment of dementia.

What are anti-psychotic drug treatments?
Neuroleptics or anti-psychotic drugs are effective treatments for people with schizophrenia, and have been widely used to treat behavioural symptoms such as aggression in people with dementia.

Are they licensed for people with dementia?
Neuroleptic drugs are licensed for the treatment of people with schizophrenia and some neuroleptic drugs are licensed to treat people with bipolar mood disorder. The drugs are used off-license for people with dementia.

What does off-license mean?
Licensing legislation requires that products must not be marketed without a license and that the license should stipulate (amongst other things) what the product should be used for. The legislation was primarily targeted at drug manufacturers and gives doctors the right to prescribe unlicensed medicine. However, it was expected that unlicensed prescribing should be the exception rather than the rule.

Should things go wrong doctors must be able to justify their reasoning and may be liable for claims of negligence (as might suppliers of the medicine). If a doctor uses a drug appropriately, as licensed, they're protected should any complications occur.

Is it illegal to prescribe someone a drug off-licence?
No. Doctors are free to prescribe outside a product license on their own responsibility. Prescribing in this way increases the doctor's professional responsibility for their prescribing decisions.

Why are anti-psychotics used to treat people with dementia?
More than half of all people with dementia experience behavioural symptoms as part of their condition, including becoming more prone to aggression. Other behavioural symptoms may include restlessness, depression, psychosis, or loss of inhibitions.

These symptoms can be distressing to people with dementia and their carers, as well as care staff - particularly if they do not have the skills to cope with this behaviour. Research confirms that older people living in care homes are particularly at risk of being inappropriately prescribed neuroleptics for behaviour that people find difficult.

There is evidence that anti-psychotic drugs have some modest benefits for some specific behavioural symptoms over short periods (6-12 weeks), particularly aggression and to a lesser extent psychosis. There is no evidence that they have any benefits after a single dose, and the longer term benefits of treatment over periods of six-months or longer are minimal.

What are the side-effects?
Side-effects include excessive sedation, dizziness and unsteadiness, which can lead to increased falls and injuries, as well as Parkinsonism (tremors and rigidity), Akathisia (body restlessness), reduced well- being, social withdrawal, accelerated cognitive decline and severe sensitivity reactions. Some of these reactions, particularly Parkinsonism, may be worse with older drugs than some of the newer treatments.