American Psychiatric Association calls for 'judicious' use of antipsychotics for people with dementia

Healthcare providers should focus on “judicious” use of antipsychotic medications when treating people with dementia, according to new guidelines from the American Psychiatric Association.

The guidelines, published this week in the American Journal of Psychiatry, acknowledge antipsychotics can be appropriate for people with dementia who exhibit severe or agitation or psychosis. But providers should assess each patient's symptoms and and possible nonpharmacological interventions before administering the drugs, experts cautioned.

The guidelines give specific suggestions for skilled nursing facilities, including keeping a log of resident's episodes of aggression or agitation, and meeting with residents' families or senior nursing staff members about a resident's preferences or behaviors.

The guidelines' authors also note that previous clinical trials have limited researchers from drawing “precise conclusions” about the benefits of antipsychotics.

“Over the last few years there have been a number of additional studies that suggest there can be harms with these medications,” author Laura Fochtmann, M.D., told MedPage Today. “As the number of older individuals with dementia increases, we want to be assured that patients are getting the most appropriate form of treatment.”

The guidelines include recommendations to taper and eventually discontinue antipsychotic use if patients experience significant side effects or see no significant response after a 4-week trial. Patients who show an “adequate” response to antipsychotics should also have their doses tapered within 4 months of starting on the drug, unless they exhibit a recurrence of symptoms during tapering or withdrawal, the authors said.

“When staff and caregivers learn to view and respond to agitation and aggression in a way that is less emotionally charged, it may also help offset compassion fatigue and burnout, which are often consequences of working with individuals with dementia,” the authors wrote.

Click here to read the full APA guidelines for antipsychotic use.