BMJ 1996;312:1667-1668 (29 June)

Letters

Access to psychiatrists should be improved

EDITOR,--Inappropriate prescribing for elderly people remains a problem, and Alice McGrath and Graham Jackson have been successful in focusing media attention on the use of neuroleptic agents in nursing homes.1 The American legislation to which the authors refer has been criticised for penalising "incorrect" drug use while offering little guidance on alternative management.2 The American Geriatrics Society is concerned that the legislation may compromise the right to effective treatment for patients with serious mental disorders and dementia in nursing homes.3

Although the legislation has reduced prescribing of neuroleptics, these reductions often cannot be maintained. For example, in the study quoted by the authors,4 neuroleptics were restarted or increased in 27-36% of cases because of a deterioration in the patient's mental state. In the same study, participating physicians were also encouraged to refer all patients taking neuroleptics for psychiatric review, which clearly has major resource implications. "Educational packages" have also been . . . [Full text of this article]


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Relevant Article

Survey of neuroleptic prescribing in residents of nursing homes in Glasgow
Alice M McGrath and Graham A Jackson
BMJ 1996 312: 611-612. [Extract] [Full Text]

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