Thursday, November 29, 2007

Antipsychotics for Dementia: A Psychiatrist Speaks

A recent comment was left by a reader (Steve B MD) who claims to be a psychiatrist. I only say "claims to be" because, hey, this is the internet, and you never know who people really are. His comment was regarding a rather lengthy post on antipsychotics for dementia. I found his comment thoughtful enough to merit its own post. Here is the second part of his comment, with my emphasis added because I could not agree with him more...
Regarding your comment that " takes time, effort, and using one's training in mental health," that just speaks to how the mental health profession (particularly psychiatry), despite its stated interest in improving the lives of patients, is too focused on the immediate effect on a patient's behavior than in long-term outcomes. As a psychiatrist, I am sometimes appalled at how my colleagues focus on the short-term benefit afforded by an unproven medication and ignore any consideration of the long-term side effects or, more importantly, other ways that the patient may learn to change his/her behavior for the better.

We have indeed been hijacked by drugs. I wouldn't entirely blame the drug companies, though, because psychiatrists have every right not to use meds in this way. It's just that our profession's knee-jerk reaction to a psychiatric symptom is to medicate, and not to help a person through his/her struggle in a more compassionate and productive way.
Amen, brother.


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E said...

I work in psychiatry and I can remember patients on an elderly care ward ten years ago being drugged up to keep them quiet. Then the drug of choice was Meleril, (Thioridizine), now off the market.

The policy was simple if they were disruptive, ie restless and wandering 10mg Meleril, if that didn't work then up the Meleril and keep increasing the dose until the patient was comatose sat in their chair.

As a newly qualified staff nurse I did not have the confidence or authority to challenge this prtactice but I do remember questioning the widom of giving a confused patient a drug that made the patient even more confused. (Often this made the agitation worse at least in the short term, until the patient lost conciousness).

In this I have to say my nursing colleagues were just as complicit as their medical colleauges. The worst offenderes were the care assistants who would bully new staff nurses like me into persuading a young SHO to prescribe the drug in the first place so that they could have a quiet life. The night staff were the worse offenders.

So I am not surprised that the same thing is going on now. Thje drugs may have changed but the practice has not.