Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia

Anne Corbett, Alistair Burns, Clive Ballard

BMJ

November 3, 2014

http://www.bmj.com/content/349/bmj.g6420

The bottom line

• Despite continued use of antipsychotics to treat agitation and aggression in people with dementia, there is limited evidence of clinically meaningful benefit
• The potential harms of antipsychotic use (including increased cerebrovascular events and mortality) outweigh the benefits
• Risperidone is the only recommended antipsychotic, and should be used only in people with dementia who have pre-existing psychotic disorders or severe aggression. It should be prescribed for no more than 12 weeks
• Careful monitoring is the best practice alternative, with evidence that alternative treatments including analgesia and non-drug based approaches provide effective options

Behavioural and psychological symptoms of dementia such as agitation and aggression are commonly treated with atypical antipsychotic drugs, which are associated with severe side effects. However, there is increasing evidence of potential harms associated with use of these drugs in people with dementia, and guidelines increasingly recommend restricting their use. In Europe, only risperidone is currently licensed for use in dementia and only for up to six weeks in patients with severe aggression, defined as causing risk or severe distress, which has not responded to other treatments. No antipsychotics are approved for this patient group in the United States. Best practice guidelines, including National Institute for Health and Care Excellence guidelines in the United Kingdom and American Psychiatric Association guidelines in the US, are similar. However, they do not distinguish between individual atypical antipsychotics and recommend a maximum treatment period of 12 weeks, except in exceptional circumstances.

Human Services and Justice Coordinating Committee

www.hsjcc.on.ca/