Low dose antipsychotics in people with dementia

1. Low dose antipsychotics in people with dementia These slides should be used in conjunction with the accompanying notes

2. Options for local implementationNPC. Key therapeutic topics – Medicines management options for local implementation. Updated July 2011 Review, and where appropriate revise, prescribing of low dose antipsychotics in people with dementia, in accordance with NICE-SCIE guidance and the NICE Quality Standard on dementia. These slides should be used in conjunction with the accompanying notes

3. Key questions What are the benefits and risks of prescribing antipsychotics for people with dementia? When is it appropriate to prescribe antipsychotics for people with dementia? What are the alternatives? What can I do to reduce the inappropriate prescribing of antipsychotics? These slides should be used in conjunction with the accompanying notes

4. About 180,000 people with dementia treated with antipsychotic medication in England per year Of these, up to 36,000 may derive some benefit from treatment, but an additional 1,800 may die and an additional 1,620 suffer a cerebrovascular adverse event (around half of which may be severe) per year If support was available to provide alternative methods of managing behavioural problems, prescribing of antipsychotics could be reduced by up to two-thirds in people with dementia. The Banerjee report The use of antipsychotic medication for people with dementia: Time for action. A report for the Minister of State for Care Services. November 2009 MeReC Rapid Review No. 847 These slides should be used in conjunction with the accompanying notes

5. NICE dementia quality standardwww.nice.org.uk/aboutnice/qualitystandards/dementia/dementiaqualitystandard.jsp People with dementia who develop non-cognitive symptoms that cause them significant distress, or who develop behaviour that challenges, are offered an assessment at an early opportunity to establish generating and aggravating factors. Interventions to improve such behaviour or distress should be recorded in their care plan. 7 c) Proportion of people with dementia with mild-to-moderate non-cognitive symptoms who are prescribed anti-psychotic medication. (Goal to be 0% ……. These slides should be used in conjunction with the accompanying notes

6. Drug interventions (1) NICE/SCIE clinical guideline No 42. November 2006 (amended March 2011) • People with dementia who develop non-cognitive symptoms or behaviour that challenges should be offered a pharmacological intervention in the first instance only if they are severely distressed or there is an immediate risk of harm to the person or others. • Choose antipsychotic after an individual risk–benefit analysis. • Start on low dose and then titrate upwards. • Limit treatment time and review regularly (at least every 3 months or according to clinical need). These slides should be used in conjunction with the accompanying notes

7. Drug interventions (2)NICE/SCIE clinical guideline No 42. November 2006 (amended March 2011) • For less severe distress and/or agitation, initially use a non-drug option • Do not use antipsychotic drugs for mild to moderate non-cognitive symptoms in: • Alzheimer’s disease, vascular dementia or mixed dementia, because of the risk of cerebrovascular events and death • Dementia with Lewy bodies because of the risk of severe adverse reactions These slides should be used in conjunction with the accompanying notes

8. NPC patient decision aidwww.npc.nhs.uk/therapeutics/cns/dementia/resources/pda_dementia_antipsychotics.pdf These slides should be used in conjunction with the accompanying notes

9. Call to actionDH.Call to action on the use of antipsychotic drugs for people with dementia. June 2011 All people with dementia who are receiving antipsychotic drugs should receive a clinical review from their doctor to ensure that their care is compliant with current best practice and guidelines, and that alternatives to medication have been considered by 31 March 2012 These slides should be used in conjunction with the accompanying notes

10. Key messages Antipsychotics are over-prescribed for the treatment of behavioural and psychological symptoms of dementia Benefits are limited, and these drugs increase the risk of death and cerebrovascular events Follow NICE/SCIE guideline for dementia People with dementia who develop non-cognitive symptoms or behaviour that challenges should be offered a pharmacological intervention in the first instance only if they are severely distressed or there is an immediate risk of harm to the person or others Prescribing of antipsychotics could be reduced by up to two-thirds in people with dementia if support was available to provide alternative methods of managing behavioural problems These slides should be used in conjunction with the accompanying notes