מתוך medicontext.co.il
By Richard Woodman
LONDON (Reuters Health) – Britain's Alzheimer's Society has announced that it is launching a major research project to find an alternative to the widespread use of tranquillisers and other "chemical coshes" in people with dementia.
The charity says it has received numerous complaints about the use of tranquillisers and antipsychotic drugs to sedate dementia patients with severe behavioural problems.
Dr. Richard Harvey, director of research, said drugs were used outside their licensed indications as a "chemical cosh" or "chemical straightjacket". He told Reuters Health, "Essentially, these drugs are being used to get the side effects. Quite often, they are given covertly, mixed with food. The level of complaints suggests that probably most care homes have at least some people with dementia who are being treated with anti-psychotics or tranquillisers."
In a statement, the society said that anti-psychotics such as chlorpromazine, haloperidol and thioridazine, and newer agents such as risperidone and olanzapine, were highly effective for treating hallucinations and delusions but there was only limited evidence to show they improved behavioural symptoms.
"Once prescription of one of these drugs has been initiated, although this may be reviewed, doctors and care staff are often reluctant to consider stopping the medication in case this results in a worsening of behaviour."
As a result, patients were often prescribed drugs for months of years even though there was little evidence of long-term benefit, even if the drugs had a positive effect in the short term.
"For most patients, the drugs cause severe and unpleasant side effects including excessive sedation, increased confusion, muscle rigidity, tremors and falls. Some research has also suggested that neuroleptic drugs reduce the life expectancy of people with dementia," the society added.
In a bid to find alternative ways of coping with disturbed patients, Dr. Harvey said that 40 care homes would take part in a unique experiment over the next four years. Half the homes would continue existing treatments but the others would be encouraged to withdraw drugs, or at least cut medication doses, and work with patients to find out what was making them disturbed.
"We have to persuade health authorities, social services and the people who run care homes that this alternative is clinically and cost effective," Dr. Harvey explained.
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