Tackling the inappropriate use of psycho-active medication in Scotland

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Dr Stella Clark, Medical Director, Primary Care, NHS Fife; Clinical lead for Mental Health Services, NHS 24 Presentation from Alzheimer Scotland conference 2011 - Creating Better Dementia Care.

Health & Medicine

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NHS Fife Old Age Psychiatry Withdrawal of Antipsychotics in patients with Dementia Quick Reference Guide Patient with Dementia on Antipsychotic Medication for >12 weeks History of severe agitation, aggression, psychosis prior to prescription Yes Seek psychiatric advice from local team who will base decision making on current SIGN/NICE guidance Other drugs Reduce by approximately 20% of the dosage every 2 weeks Quetiapine >150mgs/day Reduce by 50mgs every 2 weeks to a dose of 100mgs Quetiapine= 100mgs/day Reduce by 25mgs every 2 weeks until stopped Olanzapine >5mgs/day Reduce by 2.5mgs every 2 weeks to a dose of 5mgs Olanzapine = 5mgs/day Reduce to 2.5mg for 4 weeks and stop. Risperidone >2mgs/day Reduce by 0.5mgs every 2 weeks to a dose of 1mg Risperidone = 1mg/day Reduce to 0.5mg for 4 weeks and stop. Haloperidol >2mgs /day Reduce by 0.5mgs every 2 weeks to a dose of 1mg Haloperidol = 1mg Reduce to 0.5mg for 4 weeks and stop. Assess after 1 month to rule out Depression/anxiety/return of symptoms. Discuss with local Old Age Psychiatry team if symptoms recur ,[object Object],[object Object],Dr Stella Clark, On behalf of the Old Age Psychiatrists March 2011 No GP led reduction in medication

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