Monday, December 22, 2014

Antipsychotics and Dementia

As Alzheimer's and other dementia-related diseases progress and the damage to the brain increases, patients will often start demonstrating behaviors which can be very difficult to manage.  The patient may pace or rock back and forth.  They may experience delusions or hallucinations.  They may start screaming and may become aggressive towards other people around them, even becoming a danger to themselves or to others.  For years, these behaviors have been mitigated by the use of antipsychotic medications.

Antipsychotics were developed to treat schizophrenia which can have similar symptoms.  There's now some evidence that Alzheimer's and schizophrenia may have more in common than just a handful of symptoms.

Antipsychotics will dampen down the behaviors.  However, they may also place the person at increased risk of injury or death because the person is more likely to fall while on the medications because the side effects of the drugs include dizziness and sedation.  These drugs do not treat the cause of the behavior which may be pain.  If a patient is fighting an infection and is unable to communicate their symptoms to the care providers, the patient could be in high levels of pain which causes the challenging behaviors.  Urinary tract infections are a common example which comes to mind.Studies had suggested that antipsychotics could be reduced as a primary method of care for Alzheimer's patients.  Government recommendations were updated, guiding towards a reduction of antipsychotic use in geriatric care.

Recent reports have highlighted a reduced amount of antipsychotics are being given to dementia patients.  Closer attention has to be paid to the patient's overall physical health and more interaction with the patient must be provided to maintain a quality of life where the person is not left sitting, bored and unattended in a chair for hours.

That is challenging in a nursing home setting.  Is it impossible in a home setting?  In the home setting, there are fewer staff available to cook dinner, care for the patient, maintain the facilities and keep the patient engaged with activities.  Each home setting is different and none are regulated.  Nurses are not frequent visitors, checking on patients and their care givers.  The care givers rely very heavily upon the doctors who may be prescribing the antipsychotics to advise them on the appropriate and safe medication to give.  The care givers most likely do not know that antipsychotics are not the best choice.

It seems like there is more room for improvement, especially with regards to those patients in home care.  Their doctors should be taking the call to reduce the use of antipsychotics more seriously and reduce how much they prescribe the antipsychotics.


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