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Antipsychotics for BPSD: an audit of prescribing practice in a specialist psychiatric inpatient unit

Published online by Cambridge University Press:  01 August 2008

Camilla Haw ,
Jean Stubbs  and
Graeme Yorston
Camilla Haw*
Affiliation:
St. Andrew's Healthcare, Northampton, U.K.
Jean Stubbs
Affiliation:
St. Andrew's Healthcare, Northampton, U.K.
Graeme Yorston
Affiliation:
St. Andrew's Healthcare, Northampton, U.K.
*
Correspondence should be addressed to: Dr. Camilla Haw, Consultant Psychiatrist, St. Andrew's Hospital, Billing Road, Northampton, NN1 5DG, U.K. Phone: +44 604 616186; Fax: +44 604 616177. Email: [email protected].
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Abstract

Background: Antipsychotics are widely used for the treatment of behavioral and psychological symptoms of dementia (BPSD). In the light of the increased risk of cerebrovascular events, many countries have issued guidelines concerning their use in treating BPSD.

Methods: We carried out an audit of antipsychotic prescribing practice for inpatients with BPSD at a tertiary referral centre using standards derived from two U.K. dementia guidelines. We collated case note and prescription data and interviewed consultant psychiatrists.

Results: Of the 60 patients with dementia 50 (83%) had BPSD; of these, 28 (56%) were receiving antipsychotics. Those prescribed antipsychotics were more likely to have severe BPSD and to be aggressive and/or agitated. Audit of the 28 patients receiving antipsychotics for BPSD showed generally satisfactory results but there was room for improvement in case note documentation of off-label usage, screening for risk factors of cerebrovascular disease, consultation with relatives and use of an appropriate starting dose and slow titration of the antipsychotic.

Conclusion: Audit of the use of antipsychotics for BPSD is important given the increased mortality associated with their use. Simple audit tools as used in this study can inform clinical practice. Even at a tertiary referral centre prescribing practice could be improved.

Keywords

dementiabehavioral and psychological symptoms of dementiaaggressionatypical antipsychoticsoff-labelguidelines
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 4 , August 2008 , pp. 790 - 799
Copyright
© International Psychogeriatric Association 2008

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References

Alanen, H. M., Finne-Soveri, H., Noro, A. and Leinonen, E. (2006). Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-up. International Journal of Geriatric Psychiatry, 21, 288–295.CrossRefGoogle Scholar
Ballard, C., Waite, J. and Birks, J. (2006) Atypical antipsychotics for aggression and psychosis in Alzheimer's disease. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD003476. DOI: 10. 1002/14651858. CD003476.pub2.Google Scholar
Bianchetti, A., Trabucchi, M. and Cipriani, G. (2003). Aggressive behavior associated with donepezil treatment: a case report. International Journal of Geriatric Psychiatry, 18, 657–658.CrossRefGoogle ScholarPubMed
Bouman, W. P. and Pinner, G. (1998). Violent behavior-associated with donepezil. American Journal of Psychiatry, 155, 1626–1627.CrossRefGoogle ScholarPubMed
Duff, G. (2004). Atypical antipsychotic drugs and stroke: message from Professor Gordon Duff, Chairman, Committee on Safety of Medicines. (CEM/CMO/2004/1) http://www.info.doh.gov.uk/doh/embroadcast.nsf/vwDiscussionAll/3D8DBB48B26FF90280256E520045977A (last accessed 8 January 2008).Google Scholar
FDA Public Health Advisory (2005). Deaths with antipsychotics in elderly patients with behavioral disturbances. http://www.fda.gov/cder/drug/advisory/antipsychotics.htm (last accessed 8 January 2008).Google Scholar
Gill, S. S. et al. (2005). Atypical antipsychotic drugs and risk of ischaemic stroke: population-based retrospective cohort study. BMJ, 330, 445–450.CrossRefGoogle ScholarPubMed
Greve, M. and O'Connor, D. (2005). A survey of Australian and New Zealand old age psychiatrists' preferred medications to treat behavioral and psychological symptoms of dementia (BPSD). International Psychogeriatrics, 17, 195–205.CrossRefGoogle ScholarPubMed
Hagen, B., Esther, C. A., Ikuta, R., Williams, R. J., Le Navenec, C. L. and Aho, M. (2005). Antipsychotic drug use in Canadian long-term care facilities: prevalence, and patterns following resident relocation. International Psychogeriatrics, 17, 179–193.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. et al. (2006). Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. American Journal of Geriatric Psychiatry, 14, 561–572.CrossRefGoogle Scholar
National Collaborating Centre for Mental Health (2007). Dementia: a NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. National Clinical Practice Guideline no. 42. http://www.guidance.nice.org.uk/cg42 (last accessed 8 January 2008).Google Scholar
Royal College of Psychiatrists (2005). Atypical antipsychotics and behavioural and psychiatric symptoms of dementia. http//www.rcpsych.ac.uk/PDF/BPSD.pdf. (last accessed 25 August 2007).Google Scholar
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.CrossRefGoogle ScholarPubMed
Snowdon, J., Day, S. and Baker, W. (2005). Why and how antipsychotic drugs are used in 40 Sydney nursing homes. International Journal of Geriatric Psychiatry, 20, 1146–1152.CrossRefGoogle ScholarPubMed
Soyinka, A. and Lawley, D. (2007). Antipsychotic prescribing for behavioural and psychological symptoms of dementia. Psychiatric Bulletin, 31, 176–178.CrossRefGoogle Scholar
SPSS Inc. (2006). SPSS Base 14.0 User's Guide. New Jersey: Prentice Hall.Google Scholar
Trifirò, G., Verhamme, K. M. C., Ziere, G., Caputi, A. P., Stricker, B. H.Ch. and Sturkenboom, M. C. J. M. (2007). All-cause mortality associated with atypical and typical antipsychotics in demented outpatients. Pharmacoepidemiology and Drug Safety, 16, 538–544.CrossRefGoogle ScholarPubMed
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.Google Scholar
Yorston, G. and Pinney, A. (2000). Chlorpromazine equivalents and percentage of British National Formulary maximum recommended dose in patients receiving high-dose antipsychotics. Psychiatric Bulletin, 24, 130–132.CrossRefGoogle Scholar