Physician defends use of antipsychotics for dementia patients in nursing homes

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In response to a recent report from the Office of the Inspector General, a prominent psychiatrist is defending the practice of prescribing antipsychotic medications for nursing home residents with dementia.

The OIG report stated that off-label use of these drugs is widespread and dangerous. In his CNN.com opinion piece, Daniel Carlat, M.D., contends that just because a medication is used off-label, doesn't mean that drug's use is ineffective or “erroneous” as the OIG report states. Rather, it means that a drug hasn't undergone the expensive FDA approval process for a given indication, he said.

Furthermore, Carlat says antipsychotics are used to treat agitation associated with dementia, a symptom for which there is no approved drugs. He says agitation can be dangerous for caregivers and for the resident, but that it is especially upsetting for family members. Agitation is often the result of psychosis, Carlat writes.

Carlat argues the OIG's claim that antipsychotics can be lethal for dementia patients is questionable. He says that when antipsychotics such as Risperdal, Seroquel and Zyprexa were studied separately against placebos, there was no significant difference in the mortality rates.

While more research is needed, Carlat writes the most humane treatments for dementia patients, at the end of their lives, include any measures that calm them, including antipsychotics.
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