International Psychogeriatrics

Research Article

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

Camilla Hawa1 c1, Jean Stubbsa1 and Graeme Yorstona1

a1 St. Andrew's Healthcare, Northampton, U.K.


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.

(Received September 17 2007)

(Online publication November 21 2007)

(Revised December 23 2007)

(Accepted December 23 2007)

(Online publication February 29 2008)


c1 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: