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 Manchip.

"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 overpowered?"

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."