![]() Moreover, symptom-based prescribing could end up in psychotropic polypharmacy, since several BPSD may concur in the same person. In addition, the BPSD approach may lead in practice to symptom-oriented prescriptions, which besides, has yet not proven satisfactory. The scarcity of resources for adequate non-pharmacological and environmental interventions exerts pressure on physicians to compensate those shortcomings with medication. These guidelines, which clearly recommend non-pharmacological treatment as first option, are however difficult to implement in institutions with overburdened staff. ![]() An exception were the International Psychogeriatric Association (IPA) guidelines for the treatment of behavioral and psychological symptoms of dementia (BPSD) ( 7). In that context, prescribing optimization was neither priority, nor were there guidelines available to handle psychotropic prescribing of people with dementia in an all-encompassing way. While many scholars focused on the most urgent problem, i.e., deprescribing ( 4– 6), the concept of “chemical restraint” was elaborated in normative attempts to reduce risks associated with mostly wrongful prescriptions (e.g., Centers for Medicare and Medicaid Services, Interpretive Guidelines §483.13a Gobierno de Navarra, Decreto Foral 221/2011 Deutsches Strafgesetzbuch (StGB) §239 Freiheitsberaubung). Among this group of patients, additional concern has been raised in elders with dementia regarding psychotropics, especially long half-life benzodiazepines and all type neuroleptics ( 3).Įvidence that inadequate prescriptions exposed patients to disproportionate risks of cognitive deterioration, vascular events, injurious falls, pneumonia, and death set off several complementary lines of initiatives. Polypharmacy is a major issue for the geriatric patient in general ( 1, 2). The results of previous validation studies of this new methodology will be discussed and conclusions for future results will be drawn. This article explains the rationale that underlies a syndromic approach aimed at optimizing psychotropic treatment in people with dementia whose significant suffering derives from their thought, affective, or behavioral problems. Clinical practice, however, leads us to believe that even under optimal care conditions, psychotropics might still contribute to quality of life if based on an adequate diagnosis. Paucity of research and weakness of data are not conclusive about the adequacy of specific drugs for the myriad of cases presented by patients with dementia and comorbid conditions. ![]() By switching to syndrome-based prescription, a large proportion of drugs could be de-prescribed and some re-adjusted or kept. Two validation studies revealed that one of the main medical reasons of over- and miss-prescriptions was symptom-based prescription. The CHemical Restraints av Oidance MEthodology (CHROME) defined chemical restraint as any prescription based on organizational convenience, rather than justified with medical diagnosis. Each psychotropic drug prescription can in principle be assessed around three dimensions: (a) adequate, (b) inadequate, and (c) chemical restraint. This unfortunate reality has been reacted upon with numerous guidelines to reduce prescriptions of the most dangerous drugs (e.g., neuroleptics). One social factor is probably the frequent failure to provide adequate person-centered care, be it in the community or in institutional settings. 6Neurology Service, University Hospital Gregorio Marañón, Madrid, SpainĪ variety of medical and social factors have contributed over the last decades to the overuse of psychotropic drugs in people with dementia.5Memory Disorders Clinic, HM Hospitals, Madrid, Spain.4Albertia Servicios Sociosanitarios, Madrid, Spain.2Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.Ruben Muñiz 1 †, Jorge López-Alvarez 1,2 †, Luis Agüera-Ortiz 2,3, Luis Perea 4 and Javier Olazarán 1,5,6 *
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |