Healthy Skepticism Library item: 2377

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Publication type: news

Branswell B.
Anti-psychotic drugs often over-prescribed, study suggests
The Montreal Gazette 2005 Aug 29
http://www.canada.com/montreal/montrealgazette/news/montreal/story.html?id=9ef45685-eaf5-4499-9baa-3c22e1e284bf

Keywords:
Dementia Alzheimer's Anti-psychotic neuroleptics

Notes:

Ralph Faggotter’s Comments: In essence, this study showed that 1/3 of the time drugs to calm behaviour in dementia patients help, 1/3 of the time they dont help and 1/3 of the time they make the patient worse!
Although these medications can have a range of serious adverse effects, they are often used as chemical contrains to patch over nursing home under-staffing.

Full text:

Anti-psychotic drugs often over-prescribed, study suggests
Project prompts doctors to re-evaluate use of neuroleptics on elderly patients

BRENDA BRANSWELL
The Gazette

Monday, August 29, 2005

Staff at Maimonides Geriatric Centre in Cote St. Luc reduced the use of neuroleptic drugs among many elderly residents during a pilot project.

In a six-month study involving 120 patients, doctors began to reduce the dose or stop the medication in at least 50 cases, said Dr. Johanne Monette, a principal investigator in the study.

The anti-psychotic medication is sometimes given – too often, in the minds of some critics – to elderly patients with dementia.

“Behavioural problems in patients that have dementia … are very common. They are also very difficult to deal with,” said Dr. Brian Gore, director of research and professional services at Maimonides.

The challenging behaviour includes pacing, continually calling out, paranoia and physical aggression.

The project prompted doctors to re-evaluate the use of neuroleptics among patients every few months to see if they could reduce their use.

Gore said it appears that in about two-thirds of the cases where they tried to reduce the use of neuroleptics, there was no deterioration in patient behaviour.

Gore mentioned a “rule of three” in the drugs’ effectiveness. One third of the time, neuroleptics calm the symptoms of a patient with dementia; another third of the time, they exacerbate them and in the final third, they don’t work, Gore said.

“That’s a fairly well-accepted categorization. And in a sense it’s a warning that using the drugs should be always under revision within a short period of time.”

Early this year, Gore and research colleagues wrapped up the pilot project at Maimonides and the Institut universitaire de geriatrie de Montreal. The results for the latter facility are not yet available.

In long-term care, probably because of the shortage of physicians, Gore said, doctors might not review the patients’ medications as often as they should.

“So if it’s in your face, there is more of a chance.”

The project suggested staff first explore non-pharmacological alternatives to manage the behavioural and psychological symptoms of dementia.

In May, a study in Canadian Family Physician noted the mean average use of neuroleptics in 10 Montreal-area, long-term care facilities was 25.2 per cent, according to a survey completed in 2001.

The study said the most commonly prescribed ones were risperidone, followed by haloperidol and olanzapine.

A study of 20,000 Ontarians in long-term care facilities last year found 24 per cent of residents received anti-psychotic medication within a year of their arrival.

One downside to neuroleptics, Gore said, is that patients sometimes take more spills because they are drowsier.

The medication is sometimes appropriate and necessary, said Dr. David Conn, co-chairperson of the Canadian Coalition for Seniors Mental Health. “But I think there is sometimes a concern that they may be overused.”

The Federation of Quebec Alzheimer’s Societies says neuroleptics are over-prescribed.

“Why is that person screaming? Have we tried to figure out why?” asked executive director Nathalie Ross.

She recounted the experience of an Alzheimer’s sufferer who paced up and down the corridors of a Quebec City residence. The large man frightened staff, who decided to give him neuroleptics to calm him, Ross said. Since he kept walking – and was now at risk of falling – staff used a physical restraint on the man, who then became extremely physically aggressive, she said.
Anti-psychotic drugs often over-prescribed, study suggests

At the Alzheimer’s Society in Quebec City, where the family turned for help, staff learned the man had been a lumberjack. A volunteer was found to take him on a long walk outside every day, Ross said. “He needed to go out because he wasn’t finding what he was to used to.”

Gore said the request for neuroleptics often comes from family members. He recalled how one woman requested it for her mother, who was in an advanced state of dementia. “So we gave the drug to the patient and (she) went from wandering to a zombie.” The drug quieted the woman down, he said: “But that’s not our objective so we took it away and let her wander.”

At Baycrest Centre for Geriatric Care in Toronto where he works as a psychiatrist, Conn said staff members try to determine whether there is a contributing medical problem to a patient’s behaviour.

“A lot of patients with dementia can’t really communicate that well,” Conn said. “So even someone who may be suffering from pain could be agitated. So you’ve got to be really careful to figure out what is going on.”

bbranswell@thegazette.canwest.com