title: Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care.
abstract: To compare differences between clinician perceptions of therapeutic substitutes for antipsychotics prescribed to patients with dementia in long term care (LTC) and published evidence.
  
  
  
  A mixed-methods approach that included a drug information search, online survey of 55 LTC clinicians and a comprehensive literature review was used. For 41 pharmacologic antipsychotic substitute candidates identified, LTC clinicians rated the likelihood they would substitute each for patients with dementia and identified non-pharmacologic antipsychotic substitutes. The quality of evidence supporting the most likely antipsychotic substitutes was assessed using a modified GRADE approach.
  
  
  
  Among 36 (65%) of LTC clinicians responding, the pharmacologic candidates deemed likely or somewhat likely to be substituted for an antipsychotic were: valproic acid, serotonin modulator antidepressants, short-acting benzodiazepines, serotonin reuptake inhibitor antidepressants, alpha-adrenoceptor antagonist, buspirone, acetaminophen, serotonin-norepinephrine reuptake inhibitor antidepressants, memantine, and a cholinesterase inhibitor. High quality evidence supporting these substitutions existed for only memantine and cholinesterase inhibitors, while high quality evidence cautioning against this substitution existed for valproic acid. Activities and music therapy were the most commonly cited non-pharmacologic substitutes but the supporting evidence for each is sparse.
  
  
  
  Perceptions of LTC clinicians regarding substitutes for antipsychotics in LTC patients with dementia vary widely and are often discordant with published evidence.
authors.affiliation: a Department of Pharmacy and Health Systems Sciences, School of Pharmacy , Northeastern University , Boston , MA , USA.
authors.forename: Brianne L
authors.identifier: 0000-0001-6739-2019
authors.initials: BL
authors.lastname: Olivieri-Mui
authors.affiliation: a Department of Pharmacy and Health Systems Sciences, School of Pharmacy , Northeastern University , Boston , MA , USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
authors.affiliation: a Department of Pharmacy and Health Systems Sciences, School of Pharmacy , Northeastern University , Boston , MA , USA.
authors.forename: Aileen
authors.initials: A
authors.lastname: Ochoa
authors.affiliation: a Department of Pharmacy and Health Systems Sciences, School of Pharmacy , Northeastern University , Boston , MA , USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Schenck
authors.affiliation: a Department of Pharmacy and Health Systems Sciences, School of Pharmacy , Northeastern University , Boston , MA , USA.
authors.forename: Becky
authors.initials: B
authors.lastname: Briesacher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008134:Long-Term Care; D018377:Neurotransmitter Agents / Q000627:therapeutic use*; D010820:Physicians; D011613:Psychotherapy / Q000379:methods*
chemical_list: D014150:Antipsychotic Agents; D018377:Neurotransmitter Agents
keywords: BPSD; Dementia; antipsychotic; long-term care