Treat dementia holistically
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.