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.

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