[Antipsychotics against anxiety in dementia: medical treatment or chemical restraints?].
BACKGROUND
Antipsychotic drugs are widely used for behavioural and psychological symptoms of dementia. We discuss the evidence for this treatment and implications for clinical practice.


METHODS
Literature search on Medline was supplemented by clinical guidelines and drug reports.


CONCLUSIONS
Treatment with antipsychotic drugs for behavioural symptoms has limited effectiveness; the documentation is generally weaker for older than for newer drugs. Conventional antipsychotics give important risks of adverse events, while the newer antipsychotics imply increased risk of cerebrovascular events; hence, monitoring of effect and adverse events is imperative. Standardised methods for assessing behavioural symptoms, e.g. the Neuropsychiatric Inventory, are suitable for follow up. Controlled trials indicate that withdrawal is a feasible method for assessing actual drug effect and the need for continued treatment. Withdrawal attempts should therefore be conducted regularly for all patients taking antipsychotics for behavioural and psychological symptoms of dementia.
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, Universitetet i Bergen, 5018 Bergen. sabine.ruths@isf.uib.no
Sabine
S
Ruths
Jørund
J
Straand
D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003704:Dementia / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D009735:Nursing Homes; D017410:Practice Guidelines as Topic
D014150:Antipsychotic Agents