Anti-psychotic drugs:what to do if you are worried - alzheimer scotland information sheet is39

IS 39 January 2011
Information sheet
Anti-psychotic drugs:
what to do if you are
worried


Background
Sadly, this scenario is not uncommon, as we Alzheimer Scotland has been concerned for found at our 2010 Annual General Meeting some years about the extent of the use of experiences. It has also been recognised by the Scottish Government, which is committed to improving care and reducing inappropriate reduction in their use, while recognising that they can be helpful in some situations, if prescribed for as short a time as necessary What are antipsychotics?
and monitored appropriately. But if you are The first tranche of anti-psychotics (also worried about a family member or friend who known as neuroleptics or major tranquillisers) is receiving these drugs either in hospital or a were originally developed in the 1950s; in the 1990s a new group of anti-psychotics were “My mother was admitted to hospital under a compulsory treatment order after she was The main licensed use for anti-psychotics is for found wandering by the police in the middle of the treatment of schizophrenia or bipolar the night. The hospital gave her a drug called Risperidone then said they wanted to give her psychotics are now regularly used for the injections of Haloperidol. I said I wasn’t treatment of restlessness, aggression and happy about this but they gave her the drugs psychiatric symptoms common in people with dementia. One of these drugs (Risperidone) really unsteady on her feet and I warned the has recently been licensed specifically to treat staff on the ward that I was worried she’d severe and persistent aggression in people have a fall. Last week, she fell out of bed and broke her hip. She has gone from being a responded to other therapies. The other drugs physically fit and engaged, if confused, lady to a frail shell of a person who can’t even speak to me. I’m so worried about her and don’t know what to do as the staff don’t seem to listen to me”. Helpline caller 1 Scottish Government, 2010. Scotland’s national dementia strategy. Anti-psychotic drugs: what to do if you are worried
How do I know which drugs are
the dose reduced or the drug withdrawn if Drugs can be called by their generic name or by the trade (or proprietary) name given by Combinations of different sedative drugs are the manufacturer. The anti-psychotic drugs strongly discouraged in people with dementia. What the guidance says
(Largactil); Haloperidol (Haldol, Serenace); Scottish guidance published in 2006 (the SIGN Olanzapine (Zyprexa); Quetiapine (Seroquel); guideline) states “If necessary,
conventional anti-psychotics may be used
with caution [our emphasis], given their side
Amisulpride (Solian); Aripiprazole (Abilify); (Promazine); Sulpiride (Dolmatil, Sulparex, Also in 2006, the National Institute for Health Sulpitil); Trifluoperazine (Stelazine); Zotepine and Clinical Excellence (NICE) published a dementia guideline. A key recommendation of the NICE guidance is that people developing these distressing symptoms should first be
nursing staff which drugs are being prescribed offered an assessment to try to establish
any reasons for what is happening. This
Side effects
Side effects from anti-psychotics can include  whether the person is in pain or in ill excessive sedation, dizziness, unsteadiness, disease (shakiness, slowness and stiffness of  if the person is reacting to something the limbs), chest infections, ankle swelling and falls. But recent research has raised concerns  the person’s past history such as their about even more serious side effects such as a higher risk of strokes and premature death, particularly if the drugs are given for long  anti-psychotics should not be used as a Anti-psychotics may be particularly dangerous for people with dementia with Lewy bodies (DLB). If anyone with DLB is prescribed an 2 Scottish Intercollegiate Guideline Network, The side effects and risk of early death are 2006. Management of patients with dementia: even greater if anti-psychotics are given a national clinical guideline. (Guideline 86). 3 National Institute for Health and Clinical Excellence & Social Care Institute for Whichever drug is used, treatment with anti- psychotics should be regularly reviewed and people with dementia and their carers in health and social care. Page 2
Anti-psychotic drugs: what to do if you are worried
Before doing so, the doctor should consult involved with the person, to get their views on the person’s ability to give consent. The doctor must record on the certificate the consent of a  the dosage should start low and only proxy (such as a welfare power of attorney or guardian) if there is one; or if there is no  treatment should be time limited and proxy, that the consultation has taken place Both the proxy and the main carer have the same right to object to a proposed treatment  records should also record changes in and to use the procedure for dealing with disagreements. You can contact the Mental  staff should be trained to anticipate specialism. The second doctor must consult with you, the doctor and others with a close interest in the person. If the second doctor agrees with the first, then the treatment can go ahead. But if you still disagree you can go If the second doctor agrees with you (the proxy/carer), then the first doctor must comply or can go to the Court of Session. An Action to take
appeal to the Court of Session would require specialist legal advice and could be costly, Information is power
Family members and friends know the person best and can help medical and nursing staff to Treatment without consent can still be given in understand the person and what might trigger certificate of incapacity, in order to preserve changes in the person’s condition after receiving anti-psychotics and bring these to If the person is detained under the Mental Health Care and Treatment (Scotland) Act Know your rights about medical
2003, he or she can be given treatment for treatment
mental disorder without their consent (or There are legal safeguards applying to medical treatment for people with dementia. If a relevant decision making powers) if he or she doctor believes that a treatment will benefit a patient with dementia who is incapable of compulsory treatment order. He/she cannot consenting, the doctor should sign a certificate be treated without consent if subject to an of incapacity under Section 47 of the Adults emergency detention, unless the treatment is with Incapacity (Scotland) Act 2000 which required urgently, or he/she is being treated gives him or her authority to treat the person. Page 3
Anti-psychotic drugs: what to do if you are worried
Raising concerns
Talk to the 24 hour freephone Dementia
If you are worried about the effect of anti- Helpline on 0808 808 3000. The Helpline
psychotics or think that someone you care for cannot take direct action on your behalf but it may have been given anti-psychotics without can help to talk through your concerns and you knowing, you should discuss this in the discuss what steps to take next. With your first instance with the medical practitioner permission, the Helpline can arrange a call (consultant or GP) involved or the person in charge of the ward or care home. If you are Scotland staff to discuss your situation in more not satisfied with the explanation or outcome, put your concerns in writing. It can help to keep a diary or record of your observations This information sheet was first published as and the sequence of events (who said what an article in Dementia in Scotland December Complain
Many people worry about complaining in case it makes things worse for the person with dementia but it’s unlikely to get any better if nothing is said or done. Each hospital or care home will have a complaints procedure which Contact the Mental Welfare Commission.
Alzheimer Scotland
Their service user and carer freephone line 22 Drumsheugh Gardens, Edinburgh EH3 7RN 0800 389 6809 is open Monday - Thursday
9-5; Friday 9-4.30. The Commission will look into situations if they think that someone with a mental illness or learning disability is not Alzheimer Scotland - Action on Dementia is a company limited by guarantee, registered in Scotland 149069. Registered Office: 22 Drumsheugh Gardens, Edinburgh EH3 7RN. It is recognised as a charity by the Office of the Scottish If the person you are worried about is in a care home, you may contact the Care
Commission, the body responsible for
www.alzscot.org
regulating care service providers and making sure that they meet National Care Standards.
Tel: 0845 603 0890.

In 2009, the Care Commission and the Mental
Welfare Commission produced a report
Remember I’m still me which looked at the
quality of care for people with dementia in
care homes. The report found that a third of
the residents in the homes they looked at
were receiving anti-psychotics; there was
evidence of inappropriate and multiple
prescribing; a lack or regular reviews; and
poor recording on personal plans.
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Source: http://www.alzscot.org.uk/assets/0000/0173/IS39anti-psychotics.pdf