Expert opinion on the management of behavioural and psychological symptoms of dementia (BPSD) and investigation into prescribing practices in the UK.
BACKGROUND
The management of Behavioural and Psychological Symptoms of Dementia (BPSD) has been the subject of considerable debate over the last few years in view of the poor evidence base for pharmacological agents and concerns about their safety.


OBJECTIVE
This study sought to obtain expert opinion on the management of BPSD and to investigate current prescribing practices in the UK.


METHODS
A total of 166 expert opinion surveys were emailed to UK consultants in Old Age Psychiatry asking them to rate the appropriateness of psychotropics in different aspects of BPSD. A service evaluation was also carried out in 8 UK centres to investigate prescribing patterns.


RESULTS
Overall, 59 consultants returned completed questionnaires, a response rate of 35%. Results revealed that experts rated quetiapine as the most appropriate agent for all BPSD followed by acetylcholinesterase inhibitors for psychotic symptoms, benzodiazepines for agitation or aggression and trazodone for behavioural symptoms such as disinhibition. The service evaluations showed that benzodiazepines were most frequently prescribed for BPSD.


CONCLUSIONS
Although quetiapine was judged by experts to be the most appropriate agent for BPSD, it appears that in clinical practice benzodiazepines are most often used to manage these symptoms. Evidence from both studies show wide inconsistencies in prescribing trends.
Bishara
Delia
D
Pharmacy Department, Maudsley Hospital, London, UK. delia.bishara@slam.nhs.uk
Taylor
David
D
Howard
Robert J
RJ
Abdel-Tawab
Rauja
R
D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D006113:United Kingdom
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors