Antipsychotic drugs in dementia
Antipsychotic drugs are officially approved mainly for the treatment of schizophrenia and bipolar disorder, but they are also used for many other purposes, and one of the most controversial is reducing disruptive behavior among elderly people with dementia. In the last few years the FDA has required new warnings for drug labels, and controlled studies continue to raise questions about the risks and benefits of a practice that is still common.
Concern about this issue is not new. A federal law passed in 1987 provides that residents of nursing homes and assisted-living facilities receiving government financial support cannot be given antipsychotic drugs merely because they are wandering, insomniac, or uncooperative — that is, because staff members are inconvenienced. The drugs should be used only for agitated, aggressive, or psychotic behavior that is either distressing to the patients themselves or dangerous to others. Clinicians who prescribe the drugs must document the diagnosis and their reasons for the prescription and record all side effects.
The guidelines have not prevented continued heavy use of antipsychotic drugs in institutions for the elderly. One review of the records of 2.5 million nursing home residents found that 28% of them had received at least one prescription for an antipsychotic drug during the years 2000 and 2001. And the question is still being raised whether the drugs are prescribed inappropriately or at doses that are too high.