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National Dementia Strategy not associated with reduced antipsychotic prescribing

Antipsychotics were developed for people with schizophrenia or psychosis but are sometimes used ‘off-label’ to treat behavioural symptoms in dementia. 
Antipsychotics prescribing in dementia patients

Antipsychotics were developed for people with schizophrenia or psychosis but are sometimes used off-label to treat behavioural symptoms in dementia.

The most commonly prescribed antipsychotic used to be thioridazine but this was banned in 2008 because of evidence of cardiac toxicity. With the introduction of second-generation antipsychotics, concerns continued to be raised about their use for people with dementia.

In the UK only one antipsychotic, risperidone, is licensed for symptoms of dementia and then only for short-term treatment up to 6 weeks of persistent aggression.

Effects of strategy

This study looked at the effects of the 2009 National Dementia Strategy on prescribing of antipsychotics in care homes.

Findings showed that initial reductions have not been maintained and that older antipsychotic agents are still being used

...

Antipsychotics were developed for people with schizophrenia or psychosis but are sometimes used ‘off-label’ to treat behavioural symptoms in dementia.

antipsychotics prescribing in dementia patients
Reductions in antipsychotic prescribing in care homes have not been maintained. Picture: iStock

The most commonly prescribed antipsychotic used to be thioridazine but this was banned in 2008 because of evidence of cardiac toxicity. With the introduction of second-generation antipsychotics, concerns continued to be raised about their use for people with dementia.

In the UK only one antipsychotic, risperidone, is licensed for symptoms of dementia and then only for short-term treatment – up to 6 weeks – of persistent aggression.

Effects of strategy

This study looked at the effects of the 2009 National Dementia Strategy on prescribing of antipsychotics in care homes.

Findings showed that initial reductions have not been maintained and that older antipsychotic agents are still being used rather than safer second-generation antipsychotics.

Active support

Residents in homes served by a single GP practice were prescribed fewer antipsychotics than those with multi-practice medical support. This supports previous findings that people admitted to a home with a culture of antipsychotic use are more likely to have them prescribed irrespective of clinical indications and that care homes in deprived neighbourhoods are likely to be higher users of antipsychotics.

The researchers conclude that support is especially important in homes without nursing staff and that future research should explore reasons for variations between homes.


Szczepura A, Wild D, Khan A et al (2016) Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period. BMJ Open. 6, 9:e009882. 

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