title: Second-generation antipsychotic drug use in hospital inpatients with dementia: the impact of a safety warning on rates of prescribing.
abstract: BACKGROUND
  Behavioural and psychological symptoms of dementia are distressing for patients and are frequently treated with second-generation antipsychotics. Concerns about the drugs' safety resulted in a Medicines and Healthcare Products Regulatory Agency (MHRA) warning against their use in March 2009.
  
  
  METHODS
  Second-generation antipsychotic drug use was determined amongst patients with dementia admitted to the University Hospitals Birmingham National Health Service Foundation Trust, between July 2005 and December 2011. An interrupted time series analysis was carried out to investigate changes in rates of prescribing following the safety warning. Risperidone was analysed separately, in accordance with its limited licence for use in older adults with dementia, granted in October 2008.
  
  
  RESULTS
  Before the safety warning, second-generation antipsychotic use was increasing in patients with dementia. After the MHRA warning, their use fell by 1.9% per month compared with that before. Use of risperidone continued to rise over the same period, often against the terms of its licence.
  
  
  CONCLUSIONS
  Drug safety warnings may influence prescribing practice, although continued use of antipsychotics in dementia could reflect a lack of alternative treatment options.
authors.affiliation: School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: McIlroy
authors.affiliation: School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Thomas
authors.affiliation: School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK.
authors.forename: Jamie J
authors.initials: JJ
authors.lastname: Coleman
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy*; D004739:England; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018967:Risperidone / Q000627:therapeutic use*
chemical_list: D014150:Antipsychotic Agents; D018967:Risperidone
keywords: mental health