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Review
. 2021 Feb;44(1):8-11.
doi: 10.18773/austprescr.2020.078. Epub 2021 Feb 1.

Limiting antipsychotic drugs in dementia

Stephen Macfarlane  1   2   3 , Colm Cunningham  1   2   3
Affiliations
Review

Limiting antipsychotic drugs in dementia

Stephen Macfarlane et al. Aust Prescr. 2021 Feb.

Abstract

Most patients with dementia have behavioural and psychological symptoms. The first-line treatments for these symptoms are not drugs, but behavioural and psychological interventions Antipsychotic drugs are widely prescribed for people living with dementia. This is despite a high adverse effect burden and limited evidence of efficacy Most behavioural and psychological symptoms will subside spontaneously within six months. Trials of deprescribing are therefore recommended Behaviours should be seen as symptoms that have an underlying cause. Treatment should target these causes, rather than the resultant behaviours.

Keywords: antipsychotic drugs; behavioural symptoms; dementia; deprescribing; psychotropic drugs; risperidone.

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Conflict of interest statement

Stephen Macfarlane has received research funding from Janssen-Cilag, Eli Lilly, Eisai, Roche, Anavex Life Sciences, Prana Biotechnology, Alector, Sanofi, Pfizer, Forest, Velacor, Lundbeck, Cognition Therapeutics, Genentech. Speakers’ honoraria have been provided by Eli Lilly, Janssen, Pfizer and Lundbeck. Stephen Macfarlane has served on a Scientific Advisory Board for Eli Lilly. He is an employee of Dementia Support Australia.

Figures

Fig. 1
Fig. 1
Proportion of population accessing subsidised antipsychotic drugs in 2011
Fig. 2
Fig. 2
Antipsychotic deprescribing algorithm
See this image and copyright information in PMC

Comment in

  • Caution with olanzapine use in dementia.
    [No authors listed] [No authors listed] Aust Prescr. 2021 Apr;44(2):40. doi: 10.18773/austprescr.2021.011. Epub 2021 Apr 1. Aust Prescr. 2021. PMID: 33911330 Free PMC article. No abstract available.

References

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    1. Australian Bureau of Statistics. Patterns of use of mental health services and prescription medications: analysis of patterns of use of MBS subsidised mental health-related services and PBS subsidised mental health-related medications in 2011. Canberra: Australian Bureau of Statistics; 2016 Mar 24. https://www.abs.gov.au/statistics/health/ mental-health/patterns-use-men... [cited 2021 Jan 4]
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FURTHER READING

    1. Dementia and psychotropic medicines: understanding the options available to manage changed behaviour in this complex condition. Sydney: NPS MedicineWise; 2020. https://www.nps.org.au/ professionals/antipsychotic-medicines [cited 2021 Jan 4]
    1. Risperidone: revised PBS restrictions for behavioural and psychological symptoms of dementia. RADAR 2020 Mar 19. https://www.nps.org.au/radar/articles/risperidone-revised-pbs-restrictio... [cited 2021 Jan 4]