Doctors were warned not to prescribe antipsychotic drugs to dementia patients

Doctors are regularly prescribing two powerful psychiatric drugs to elderly dementia patients despite a safety warning in 2004, the BBC has found.

File On 4 questioned 355 GPs and found more than half prescribed the drugs risperidone and olanzapine.

The former Committee on Safety of Medicines (CSM) warned the drugs risked strokes in elderly dementia patients.

Prescribing the drugs was indefensible for many dementia patients, Ivan Lewis, Minister for Care Services, said.

A BMA official said the doctors were prescribing for patients who were a physical risk to themselves and others.

The CSM considered research evidence for risperidone and olanzapine - two widely sold drugs and usually used for conditions such as schizophrenia - sending an urgent message to GPs four years ago.

"Evidence reviewed by the Committee on Safety of Medicines indicates an increased risk of stroke which particularly applies when these drugs are used by elderly people with dementia," the CSM said.

FIND OUT MORE Listen to File On 4, Radio 4 Tuesday 17 June 2008 2000 BST, repeated Sunday 22 June 1700 BST Or catch up at Radio 4's Listen Again site

It added: "The Committee has advised that risperidone or olanzapine should not be used for the treatment of behavioural symptoms of dementia."

File On 4 commissioned research company Medix to question a group of GPs in the UK about their prescribing habits.

Drug of choice

Only 15 doctors out of 355 questioned said they would never use anti-psychotic medication for dementia patients.

The rest cited several symptoms for which they would prescribe such drugs, including aggression, inappropriate behaviour, disinhibition, wandering or being noisy.

READ WHAT THE DOCTORS PRESCRIBE File On 4 questions to doctors [146KB] Most computers will open this document automatically but you may need Adobe Reader. Download the reader here

Some 53% has similarly prescribed olanzapine.

Violence risk

The questionnaire also found that some doctors prescribed anti-psychotic drugs to 90% of their patients.

Dr Lewis Morrison, chair of the community care committee of the British Medical Association, explained why the government advice was overlooked.

It shouldn't be happening Ivan Lewis, Minister for Care

"I think it happens because situations arise where the patient is physically very disturbed and is at risk of doing violence to themselves or others," he told File On 4.

Dr Morrison added that doctors sometimes had to prescribe drugs without any guidelines or evidence about side-effects.

But he also stated: "I'm not going to pretend that every single incidence of the usage of those drugs [risperidone and olanzapine] in the face of the advice is appropriate.

'Awful indictment'

"I would say that training in the use of these drugs is absolutely key or, more importantly, perhaps training in the use of other things including non-drug treatments."

But Dr Tim Kendall, of government agency NICE (The National Institute for Health and Clinical Excellence), said it was horrifying that some GPs were prescribing these drugs for up to 90% of their dementia patients and it was an "awful indictment."

He added: "I think the doctors should be disciplined.

"A doctor prescribing for 90% of their patients an anti-psychotic when there is enough guidance to say don't - it's unacceptable."

Care minister Ivan Lewis, told the File On 4, "It shouldn't be happening."

He added: "One of the things we will be considering is how do we toughen enforcement in this area."

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