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Treat dementia holistically

Vol. 8, No. 1 / January 2009

The authors of “Antipsychotics in dementia: Beyond ‘black-box’ warnings” (Current Psychiatry, June 2008) comment that the list of drugs being taken by Mrs. B is revealing for reasons that, unfortunately, are not rare. If the reasons were rare, this likely would be a much shorter article. Despite repeatedly being catheterized, Mrs. B has bladder distention. She also has fecal impaction. She is said to be getting one-to-one care, so why isn’t staff aware of “input/output” issues? If they were aware, did they communicate this to the treating psychiatrist? It is not surprising that Mrs. B became agitated.

More disturbing is that the care facility obtained informed consent at admission. This is not so much an issue of authority as of having a family member or proxy decision-maker in the loop with a “big picture” perspective.

There may be instances when atypical antipsychotic drugs are indicated. However, my sense is that these drugs have the effect of lowering the volume on a TV set; it’s still turned on.

Samuel Lyons
Alexandria, VA

To comment on articles in this issue or other topics, send letters in care of Erica Vonderheid, Current Psychiatry, 110 Summit Avenue, Montvale, NJ 07645, or click here.

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