Antipsychotics for BPSD: an audit of prescribing practice in a specialist psychiatric inpatient unit.
BACKGROUND
Antipsychotics are widely used for the treatment of behavioral and psychological symptoms of dementia (BPSD). In the light of the increased risk of cerebrovascular events, many countries have issued guidelines concerning their use in treating BPSD.


METHODS
We carried out an audit of antipsychotic prescribing practice for inpatients with BPSD at a tertiary referral centre using standards derived from two U.K. dementia guidelines. We collated case note and prescription data and interviewed consultant psychiatrists.


RESULTS
Of the 60 patients with dementia 50 (83%) had BPSD; of these, 28 (56%) were receiving antipsychotics. Those prescribed antipsychotics were more likely to have severe BPSD and to be aggressive and/or agitated. Audit of the 28 patients receiving antipsychotics for BPSD showed generally satisfactory results but there was room for improvement in case note documentation of off-label usage, screening for risk factors of cerebrovascular disease, consultation with relatives and use of an appropriate starting dose and slow titration of the antipsychotic.


CONCLUSIONS
Audit of the use of antipsychotics for BPSD is important given the increased mortality associated with their use. Simple audit tools as used in this study can inform clinical practice. Even at a tertiary referral centre prescribing practice could be improved.
Haw
Camilla
C
St Andrew's Healthcare, Northampton, UK. chaw@standrew.co.uk
Stubbs
Jean
J
Yorston
Graeme
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000187:drug effects / Q000523:psychology; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D054869:Clinical Audit; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004739:England; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D012920:Social Behavior Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology
D014150:Antipsychotic Agents