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APA Develops New Guidelines on Use of Antipsychotics by Patients With Dementia
The American Psychiatric Association (APA) has developed a set of new evidence-based guidelines on prescribing antipsychotics to treat agitation or psychosis in patients with dementia.
An overwhelming majority of older adults with dementia will develop agitation or psychosis, and treatment for those symptoms often involves antipsychotic medications, according to the APA. But evidence from recent clinical trials shows the antipsychotics have little benefit and are linked to negative effects such as increased risks of cognitive decline and death, the APA said in a statement.
“While the use of antipsychotics is appropriate for some patients with dementia, it can be difficult to identify the individuals and the specific circumstances,” said APA President Renée Binder, MD. “A decision should be made only after thorough assessment and review of potential benefits and harms of antipsychotic treatment as well as other possible treatment options.”
The 15 guidelines cover assessment of the patient and the risks and benefits of antipsychotics, development of a treatment plan, and specifics for the use of antipsychotics. They include:
- Using nonemergency antipsychotics in patients with dementia only when agitation and psychosis symptoms are severe, dangerous, or cause the patient significant distress;
- Beginning treatment at a low dose and moving up to the minimum effective dose;
- Attempting to taper off and withdraw the antipsychotic within 4 months if the patient shows adequate response, and within 4 weeks if there is no significant response.
The guidelines were developed by the APA Practice Guideline Writing Group, consistent with recommendations of the Institute of Medicine (IOM), the Agency for Healthcare Research and Quality (AHRQ), and the Council of Medical Specialty Society.
The Executive Summary of the guidelines appears in the May issue of The American Journal of Psychiatry and the full set of recommendations is available on PsychiatryOnline.org.
—Terri Airov
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