20 March 2012

How 'understanding the person' is reducing reliance on medication

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) is proving that a healthy dose of respect is sometimes the best medicine.

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.

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. While this led to a drive to reduce the prescribing of such medication, the issue was what to replace it with. The answer seems to be quite simple: understanding the patient.

AWP's Consultant in Old Age Psychiatry, Dr Simon Manchip says that 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?"

The staff found that adopting different approaches for different people helped, although there were some rules which applied to all. "If a patient is sitting, we sit to talk to them so they feel less intimidated. It seems very simple but the figures are showing that it's very effective."

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.

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. General Practitioners are prescribing less and liaising with AWP in most cases before prescribing. Very importantly, 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."

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