Published 9 July 2008, doi:10.1136/bmj.a602
Cite this as: BMJ 2008;337:a602

Editorials

Antipsychotics for people with dementia

Should be reserved for severe and persistent symptoms after assessment of risk and benefit

The first 150 words of the full text of this article appear below.

More than 25 million people worldwide have dementia, with a new case developing every seven seconds.1 While putative disease modifying agents are being developed, we are limited to symptomatic treatments for cognitive and non-cognitive features. Non-cognitive symptoms—referred to as behavioural and psychological symptoms of dementia—including agitation, psychosis, depression, and aggression, occur in up to half of those with dementia in the community and an even higher proportion in residential care. Antipsychotics have been widely prescribed off licence for these symptoms, and 20-50% of people with dementia in institutional care receive them.2 What is the evidence for their efficacy?

Several placebo controlled, randomised controlled trials (RCTs), especially of newer "atypical" antipsychotics like risperidone, show an improvement in agitation, aggression, and psychosis.3 But, even before current concerns over their side effects, the strength of the evidence supporting widespread prescribing in dementia was questioned. Efficacy is modest, and most studies have assessed behavioural . . . [Full text of this article]

John O’Brien, professor of old age psychiatry

1 Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE

j.t.obrien@ncl.ac.uk


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Rapid Responses:

Read all Rapid Responses

it's all about the patient
Paddy Quail
bmj.com, 10 Jul 2008 [Full text]
Antipsychotic prescribing in care homes is a marker of system failure.
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