BMJ 1996;312:1668 (29 June)

Letters

Substantial study is imminent

EDITOR,--Alice McGrath and Graham Jackson's survey of neuroleptic prescribing in nursing homes is a timely addition to the scant British literature on this important subject.1 They report a high prevalence of "inappropriate" neuroleptic prescribing according to American guidelines. However, judging appropriateness by guidelines fails to recognise the potential complexity of the decision to prescribe neuroleptics for patients with dementia.2 For example, the term wandering subsumes a variety of behaviours, including leaving exits, trailing of carers, and persistent, purposeless pacing. The latter is often not amenable to environmental manipulation and may be construed as organically driven and therefore more suitable for pharmacological intervention than other types of wandering.3 Similarly, the term agitation describes so many behaviours that it is almost meaningless. What is required is a thorough effort to understand the patient's predicament, from which flows proper management of needs and any behaviour problems, including the judicious use of psychotropic drugs, . . . [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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