Dementia and psychotropic medicines

Understanding the options available to manage behavioural and psychological symptoms in this complex condition

 

For consumers, check out
 Medicines and dementia: what you need to know

Dementia and psychotropic medicines

Key points

  • Non-pharmacological interventions are recommended as first-line management of behavioural and psychological symptoms of dementia (BPSD), and should be continued even if a medicine is trialled.
  • Health professionals are encouraged to be guided by a patient’s background, likes and dislikes, culture and life experiences to choose appropriate non-pharmacological interventions.
  • Where psychotropic medicines are used, review early and often for the emergence of adverse effects.
  • Antipsychotic medicines should only be used in severe cases of BPSD where non-pharmacological interventions have failed.
  • Consider ceasing an antipsychotic medicine if the targeted behaviour has not improved after 1–2 weeks, or if the patient has been taking the medicine for at least 12 weeks.
 

Reviewing and tapering antipsychotic medicines for BPSD

A tool to facilitate multidisciplinary review of antipsychotic medicines prescribed for patients experiencing BPSD, including advice on how and when to taper.

 

Australian Prescriber articles

Managing behavioural and psychological symptoms in dementia

Stephen Macfarlane, Daniel O’Connor Aust Prescr 2016;39:123–5

Behavioural and psychological symptoms should be managed without drugs whenever possible. Although there is little evidence to support their use, antipsychotic drugs are often prescribed to people with dementia.

Read the full article

Combination psychotropic medicine use in older adults and risk of hip fracture

Kerrie Westaway, Natalie Blacker, Russell Shute, Rosemary Allin, Zain Elgebaly, Oliver Frank, Nicole Pratt, Elizabeth Roughead Aust Prescr 2019;42:93–6

Falls typically result from multiple interacting factors. The more factors present, the more likely the person is to fall.

Read the full article

Stopping and switching antipsychotic drugs

Nicholas Keks, Darren Schwartz, Judy Hope Aust Prescr 2019;42:152–7

While antipsychotics are often needed long term, there are circumstances when clinicians, patients and families should reconsider the benefits versus the harms of continuing treatment. Care is needed to avoid psychosis during the changeover.

Read the full article

 

Choosing Wisely Australia

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Choosing Wisely Australia is an initiative that brings the community together to improve the quality of healthcare through considering tests, treatments and procedures where evidence shows they provide no benefit or, in some cases, lead to harm.

Led by Australia’s colleges, societies and associations and facilitated by NPS MedicineWise, Choosing Wisely Australia challenges the way we think about healthcare, questioning the notion 'more is always better'

Recommendations from Australian and New Zealand Society for Geriatric Medicine

Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia.

Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium.

    Recommendation from The Society of Hospital Pharmacists of Australia

    Do not initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months.

      Recommendation from Pharmaceutical Society of Australia

      Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than 3 months without review.

      Clinical resources and tools

      Reviewing and tapering antipsychotic medicines for BPSD

      A tool to facilitate multidisciplinary review of antipsychotic medicines prescribed for patients experiencing BPSD, including advice on how and when to taper.

      Implementing non-pharmacological interventions for BPSD

      A resource for health professionals and care staff that provides non-pharmacological strategies suitable for implementation in an aged care setting.

      Stepwise approach to BPSD

      A resource for health professionals and care staff that demonstrates a stepwise approach to managing BPSD.

      Stepwise approach to BPSD

      Date published : 17 January 2020

       

      Dementia Training Australia: BPSD Quick Reference Cards

      Available on the Dementia Training Australia website, these cards are a resource for health professionals and care staff working with people with dementia to help guide the management of BPSD.

      Download the cards

      The DementiaKT Hub: Dementia Outcomes Measurement Suite

      A compendium of validated tools to help health care professionals assess various aspects of dementia.

      View the suite

       

      Research summary

      Authors

      Reference

      Summary

      Dementia Collaborative Research Centre, 2012

      Behaviour management a guide to good practice – Managing behavioural and psychological symptoms of dementia

      This guide supports health professionals and care staff caring for people living with dementia, who present with behavioural and psychological symptoms of dementia (BPSD). A comprehensive evidence and practice-based overview of BPSD management principles is provided, with practical strategies and interventions.

      Royal Australian and New Zealand College of Psychiatrists, 2016

      Professional Practice Guideline 10: Antipsychotic medications as treatment for behavioural and psychological symptoms of dementia

      These guidelines provide health professionals with recommendations reflecting current evidence on antipsychotic medicine use for patients with BPSD.

      Guideline Adaptation Committee, 2016

      Clinical practice guidelines and principles of care for people with dementia

      These guidelines provide health professionals and carers in primary care, aged care and hospital settings with access to recommendations reflecting current evidence on dementia care to better respond to the needs and preferences of the person living with dementia.

      Westbury et al, 2017

      Reducing the use of sedative medication in aged care facilities: Implementation of the ‘RedUSe’ project into everyday practice

      RedUSe is a University of Tasmania national project that promotes the appropriate use of sedatives, in particular antipsychotics and benzodiazepines, in residential aged care facilities (RACFs) in Australia.

      RedUSe is a multi-strategic, interdisciplinary and structured initiative that has proven an effective intervention to significantly reduce RACF antipsychotic and benzodiazepine use, with high degrees of staff, pharmacist and GP satisfaction.