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Antipsychotics for BPSD: an audit of prescribing practice in a specialist psychiatric inpatient unit

Published online by Cambridge University Press:  01 August 2008

Camilla Haw ,
Jean Stubbs  and
Graeme Yorston
Camilla Haw*
Affiliation:
St. Andrew's Healthcare, Northampton, U.K.
Jean Stubbs
Affiliation:
St. Andrew's Healthcare, Northampton, U.K.
Graeme Yorston
Affiliation:
St. Andrew's Healthcare, Northampton, U.K.
*
Correspondence should be addressed to: Dr. Camilla Haw, Consultant Psychiatrist, St. Andrew's Hospital, Billing Road, Northampton, NN1 5DG, U.K. Phone: +44 604 616186; Fax: +44 604 616177. Email: chaw@standrew.co.uk.
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Abstract

Background: Antipsychotics are widely used for the treatment of behavioral and psychological symptoms of dementia (BPSD). In the light of the increased risk of cerebrovascular events, many countries have issued guidelines concerning their use in treating BPSD.

Methods: We carried out an audit of antipsychotic prescribing practice for inpatients with BPSD at a tertiary referral centre using standards derived from two U.K. dementia guidelines. We collated case note and prescription data and interviewed consultant psychiatrists.

Results: Of the 60 patients with dementia 50 (83%) had BPSD; of these, 28 (56%) were receiving antipsychotics. Those prescribed antipsychotics were more likely to have severe BPSD and to be aggressive and/or agitated. Audit of the 28 patients receiving antipsychotics for BPSD showed generally satisfactory results but there was room for improvement in case note documentation of off-label usage, screening for risk factors of cerebrovascular disease, consultation with relatives and use of an appropriate starting dose and slow titration of the antipsychotic.

Conclusion: Audit of the use of antipsychotics for BPSD is important given the increased mortality associated with their use. Simple audit tools as used in this study can inform clinical practice. Even at a tertiary referral centre prescribing practice could be improved.

Keywords

dementiabehavioral and psychological symptoms of dementiaaggressionatypical antipsychoticsoff-labelguidelines
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 4 , August 2008 , pp. 790 - 799
Copyright
© International Psychogeriatric Association 2008

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