title: Factors influencing the prescribing of medications by old age psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study.
abstract: BACKGROUND
  despite evidence of limited efficacy, psychotropic medications are widely used as a first line treatment for those with behavioural and psychological symptoms of dementia (BPSD). Clearly various factors must be influencing their continued use; these are explored here.
  
  
  OBJECTIVE
  to examine the process by which consultant old age psychiatrists prescribe for BPSD and explore the factors that influence their decisions.
  
  
  METHODS
  a focus group generated initial questions for interviews with eight consultant old age psychiatrists, using a grounded theory methodology.
  
  
  RESULTS
  differences in how assessment information was utilised resulted in inconsistencies in choice of medication between psychiatrists. Psychiatrists felt pressured to prescribe, largely due to resource issues and lack of viable alternative treatments.
  
  
  CONCLUSIONS
  the ways in which psychiatrists prescribe for BPSD varies amongst clinicians. Guidelines do exist, but are difficult to implement in practice. Alternative non-pharmacological strategies are required, but as yet they are difficult to access and have a questionable evidence base.
authors.affiliation: Northumberland Tyne and Wear NHS Trust, Northumberland, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Wood-Mitchell
authors.forename: Ian Andrew
authors.initials: IA
authors.lastname: James
authors.forename: Anna
authors.initials: A
authors.lastname: Waterworth
authors.forename: Alan
authors.initials: A
authors.lastname: Swann
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
mesh_terms: D002755:Choice Behavior; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions; D004739:England; D019317:Evidence-Based Medicine; D017144:Focus Groups; D005852:Geriatric Psychiatry; D019983:Guideline Adherence; D006299:Health Services for the Aged; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D036301:Qualitative Research; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs