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Research and Impact

Alternatives to Antipsychotic Medication - Psychological Approaches in Managing Psychological and Behavioural Distress in People With Dementia

13 January 2017

The attached briefing paper presents the Society's review of the evidence for the use of non-pharmacological alternatives to antipsychotic medication.

There are approximately 800,000 people currently living with dementia in the UK, with approximately a third of this number residing in a care home (Alzheimer’s Society, 2011).

It has been predicted that by 2021 there will be over one million people living with dementia.

It is important to remember that many of the behaviours identified as challenging are not symptoms of dementia, rather they are symptoms of human distress, disorientation and misperception. As such, it seems counterproductive to frequently treat such behaviours through tranquilisation and sedation without first attempting to deal with the distress and cognitive confusion.

In practice however antipsychotic medication is often used as a first-line treatment for behavioural difficulties rather than as a secondary alternative (Alexopoulos et al., 2005; Alzheimer’s Society, 2009), despite the evidence that antipsychotic drugs have a limited positive effect and can cause significant harm to people with dementia (Schneider, Dagerman & Insel, 2006; Ballard, Lana, Theodoulou, Jacoby, Kossawakowski, Yu & Juszczak, 2008; Banerjee, 2009).

Recently however the Department of Health in England has stated that the use of antipsychotic medication for people with dementia needs to be reduced, and there have since been a number of initiatives taken to address the need for a reduction in the use of antipsychotics.

The work presented by this document serves to highlight the evidence-based alternatives to antipsychotic medication for people with dementia and shows that if these alternatives are organised in a staged approach (that is, a stepped care approach) then access to these interventions can be increased and reliance on antipsychotics reduced accordingly.

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