18 July 2012
AWP at the forefront of reducing antipsychotics
Over the last few years there has been increasing concern about
the use of antipsychotics (major tranquillisers) to control
behavioural symptoms in people with dementia, with the perception
that they may have been used as a "chemical cosh" to sedate
patients as a quick fix to their problems. Only this week, the NHS
released figures showing that there is a move away from
antipsychotics although this came as no surprise to AWP's
Consultant in Old Age Psychiatry, Dr Simon Manchip. "General
Practitioners are prescribing less and liaising with AWP in most
cases before prescribing," he says.
An audit of current antipsychotic usage was completed in
February this year and showed the current rate of prescriptions in
Swindon for people with dementia is just 8%. This is probably
one of the lowest rates in the whole of the United Kingdom. All
prescriptions which are now given are time limited and in most
cases the stop date for the medication is written on the start date
to avoid prolonged unnecessary prescriptions.
These drugs also raised concerns with the Department of Health
that they may have been in some way responsible for nearly 2000
excess deaths nationally and 1600 strokes. The Department asked Dr
Manchip and AWP's Clinical Pharmacist Terri Turner to contribute to
the national reduction programme.
"I am pleased that joined up work with GPs, care home staff and
ourselves is showing benefits, not just in reducing inappropriate
prescribing but importantly that patients do not remain
'unreviewed' on these medications for long periods of time as this
is a major factor in reducing the death rates," says Dr
"Antipsychotics can, in some circumstances, be replaced with
very simple methods of 'understanding the person'. We discovered
that bathing times were a trigger for physical aggression in some
patients, and this was down to our well-meaning effort to ensure
patients bathed or showered at least once a day," he explains.
"Some of our patients chose to bath just two or three times a
week so every day was difficult for them. The sense of difficulty
came out as aggression. This is what we mean by understanding the
person; what are they used to? What prevents them from feeling
Dr Manchip is keen to point out that working in partnership has
been key to the success of the project. "It is a real joint
approach. As with GPs, all the care homes we work alongside are
looking at non drug ways of helping their residents more and more.
We believe that this medication still has a role to play for
certain patients with dementia but knowing where it will not be
effective is increasingly important."