Routine usage of anti-psychotic drugs for behavioural and delusional challenges of people living with dementia has decreased somewhat throughout the world over these past ten years. It is now 'supposed' to be a process of last resort. These drugs are linked to very serious side effects, have essentially moderate or no benefit at all for the dementia patient, and, prescribers do not address underlying causes of behavioral issues in dementia.
Inappropriate prescription of antipsychotic drugs is extremely harmful. Research has shown that there is a greatly increased risk of heart attacks and strokes when given to dementia patients. Drug manufacturers of anti-psychotic drugs operate under very rigid licensing regulations for usage of their drugs.
But a very major problem appears to be "off label" prescribing of these drugs by individual health care professionals just for their own personal convenience. Psychological and alternative therapies seem to be dismissed by many in the medical profession. There is no specific legislation banning "off label" prescribing of anti-psychotics to those with dementia. The process is left to "good practice" guidelines administrated through relevant medical-governing councils in their own national jurisdictions.
But a very major problem appears to be "off label" prescribing of these drugs by individual health care professionals just for their own personal convenience. Psychological and alternative therapies seem to be dismissed by many in the medical profession. There is no specific legislation banning "off label" prescribing of anti-psychotics to those with dementia. The process is left to "good practice" guidelines administrated through relevant medical-governing councils in their own national jurisdictions.
In 2008 my 56 year old wife suffered a serious "psychotic incident." She was prescribed a powerful and strictly monitored anti-psychotic called clozapine. At the time she did not have an MRI brain scan, as a neurologist believed she was "too young" to check for dementia. However, in 2013 via MRI brain scan, official diagnosis was changed to early onset rare fronto-temporal dementia (FTD). A review to discontinue clozapine should have been considered by the original prescribing psychiatrist in 2013. That review never happened.
From 2008-2017 my wife was subjected to a series of harmful side-effects from clozapine, some irreversible. That included heavy sedation, constant weakness and dizziness, tremors, acceleration of cognitive decline, massive weight gain, increased aggravation of diabetic condition, liver impairment, urinary incontinence, and, excessive hyper-salivation. It also contributed to lowering platelet and white blood cells counts, thereby decreasing her body's ability to fight infections. These side effects are in addition to increased chances of a fatal stroke or heart attack.
In 2017, turning 65, my wife was transferred to an Older Adult Mental Health Care Team. At this point I compiled a six-page report of her experiences to be given to a new psychiatrist, with the view to discontinue clozapine. That consultant agreed with my proposals. Over a six month period clozapine dosage was gradually reduced to total discontinuance. Through reviews and activities enhancing quality of life, alternative therapies are now used. Results have been beneficial for my wife.
In my contact with the UK General Medical Council, it suggested that my wife's original psychiatrist ( now retired ) continually prescribing clozapine did not follow "good practice" in her ongoing care. By expressing concerns through our local Member of Parliament, I received feedback from the highest levels of the UK Department of Health & Social Care and Parliamentary Health Committees. They assured me that issues of prescribing anti-psychotics to dementia patients is to be covered in an upcoming national dementia strategy implementation ( i.e Dementia Challenge Plan - 2020 ).
Regardless of what country in which you reside, family and carers of people living with dementia should not feel intimidated from questioning medical professionals to ensure informed choice and consent regarding use of anti-psychotics. Holding Lasting Power of Attorney (LPA ) in health and welfare affairs is also advisable. [ In UK that is registered with Office of Public Guardian ).
Technically, inappropriate use of anti-psychotics with dementia patients can be interpreted as abuse of their human rights. In fact, a recent report ( February, 2018 ) by the international organisation HUMAN RIGHTS WATCH condemned their use in US-based residential care homes.
