Low dose antipsychotics in people with dementia

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					       Low dose antipsychotics in people
                with dementia

    These slides should be used in conjunction with the accompanying notes



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          Options for local implementation
    NPC. 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.




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          These slides should be used in conjunction with the accompanying notes
                             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?




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         These slides should be used in conjunction with the accompanying notes
                              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

         • 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.


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                These slides should be used in conjunction with the accompanying notes
                    NICE dementia quality standard
    www.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.
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               c) Proportion of people with dementia with mild-
               to-moderate non-cognitive symptoms who are
               prescribed anti-psychotic medication. (Goal to
               be 0% …….
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                These slides should be used in conjunction with the accompanying notes
                        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).
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            These slides should be used in conjunction with the accompanying notes
                       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




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




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            These slides should be used in conjunction with the accompanying notes
                                   Call to action
    DH. 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
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                 These slides should be used in conjunction with the accompanying notes
                              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
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           These slides should be used in conjunction with the accompanying notes

				
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