While I wouldn't exactly argue that antipsychotics are good for patients with dementia, I do understand why they are used, especially in hospitals.

Let's say there is a confused elderly person with very brittle bones who keeps climbing over the bed rails. If he falls and cracks his skull open which is a very real possibility, the hospital is liable. Medicare WILL NOT pay for sitters in hospitals. The family doesn't want to stay with the patient 24 hours a day, because they have to work so it's up to the hospital to keep this patient safe. What are the options?

The nurse has 6 patients. They cannot sit by that patient's bedside for 24-hours every day. They have 5 other patients who need medication and also need care. They can choose to take no action, in which case the patient very likely WILL fall and being elderly the risks for a broken hip or worse is high, the family sues because the hospital didn't keep their family member safe, and so on. Or they can put the patient in physical restraints, which seems cruel. Or, they can chemically restrain the patient. Why doesn't Medicare pay for sitters?

It seems to me that in this case the people that need to face the wrath, are not the doctors, nor is it the pharmaceutical companies, it's those who refuse to cover sitters which are often necessary in safely caring for patients who are confused. This forces the hospital to either eat the cost of a sitter (which isn't cheap) or take other measures to keep the patient safe.

"Why do so many doctors believe that these drugs are useful for noisome children and adults with agitation? Would any doctor care to explain to me the casual use of these drugs in our culture?"

Because sometimes, physicians are treating the caretakers, not the patient. And prescribing gives everyone the sense that "something is being done".

The word 'anti-psychotic' is a marketing term that has no real scientific basis. No known substance has an effect that targets 'psychosis' or 'delusions' any more specifically than a cast iron skillet to the back of the head. I know from personal experience of being forced to take them that the drugs 'work' by disrupting the higher mental functions. It takes higher functions to see connections where none exist and to hear things that other people don't hear, and also to think for one's self instead of just following orders.

When they first put me on risperidal, I shut up right away about my 'delusions' because I couldn't really understand Aristotle and Buddhism any more. I became good and compliant because I couldn't hold a complicated thought in my head any more to put together all the little pieces that add up to the system of control of 'inpatients' on a locked ward. I could only focus on how it was an hour from group till lunch, and then four and a half hours till dinner. This is the mechanism by which neuroleptics reduce 'psychosis' and reduce agitation and reduce people's troublesome thought and behavior; to the degree that they work at all, it is by reducing everything about a person.

This includes severely reducing life-span. Thank God it's now generating some outrage that neuroleptics are killing our parents and grandparents, but for years it's been common knowledge that people with schizophrenia labels who take neuroleptics their whole lives die decades early, and hardly anyone seems outraged about that.

I know there are some situations that are so desperate that taking highly dangerous drugs, especially very short-term, may be the least awful of very limited options. I'm certainly not suggesting banning them completely.

But let's not kid ourselves that neuroleptics are any less damaging to a 19-year-old newly 'diagnosed' with 'schizophrenia' than they are to an elderly Alzheimer's patient in a 'nursing home.' Let's be honest that neuroleptics aren't a medicine that treats an illness when they're used on the most loudly raving 'psychotic' any more than when they're used to stop bored boys from disrupting their classes or to keep suffering seniors quiet in understaffed 'nursing homes.'

Neuroleptics are chemical restraints that exert their effect by interfering with the higher functions of the mind, to make people simpler and less willful, and therefore easier for other people to deal with. Anyone who doesn't believe me, or is too wrapped up in the biopsych propaganda to get their heads around that fact, ought to go out and try, under a psychiatrist's supervision of corse, a dose or two for themselves.

Thanks UnderTheThresher, you are correct.

I've said it before and I'll say it again (and probably again and again, knowing me): I'd MUCH rather be tied to a chair than drugged, thank you.
Sherry

"Because sometimes, physicians are treating the caretakers, not the patient. And prescribing gives everyone the sense that "something is being done"."

Maria, how unfortunate that you have come to this conclusion. This might be based on your personal insight, but certainly does not represent all caretakers, and for a new professional as yourself to make this statement, makes me personally ill.

Stephany at soulful sepulcher, a behind the scenes parent where you got started. Shame on you!

I hear a lot of criticism here, but I don't hear any alternatives. The reality is if an elderly person with dementia in the hospital, is agitated and continually climbing over the bedrails, they are at high risk for falling which with an elderly person can be very bad. Medicare doesn't cover sitters, so that option isn't always available. Are the medical staff just supposed to ignore the fact that the patient is agitated and continually climbing over the bedrails, and just hope for the best, or what do some of you suggest? It would be nice if family members would sit there by the patient's bedside for 24 hours every day and calm the patient and be at their bedside when they fly over the bedrails, but that's not reality in most cases.

I know that people are going to say, well it's being done for convenience, which may be true in some cases, and I don't suppport that. However, many people with dementia experience sundowners and become more confused and agitated at night, so is it wrong to give them a med to calm them and help them sleep? Or do we just ignore it and hope when they fly out of bed they don't crack their skull open?

My grandfather died from Alzheimer's disease. I have no problem whatsoever with the fact that he was given antipsychotics. None. And, I loved him dearly.

I agree that antipsychotics are overprescribed. I do not support the fact that they are handed out for insomnia in patients without psychosis or dementia. That's being done, and I think it's screwing up a lot of people's lives. But, with dementia I think it's a different situation.

To make it a little more realistic here's a made up example (but one that happens often in hospitals).

Mr. Jones is a fictious 91 year old male in Room 1 with a UTI and history of dementia, osteopenia, multiple falls, multiple fractures, and an unsteady gait. Oh, by the way he's on Plavix & Aspirin to prevent stroke so he's a bleed risk. Mr. Jones is very agitated. All of his family live in Timbucktoo, and they're not coming. They will call you every five minutes to check on him, however. Mr. Jones says he has to go build a fire in the fireplace, and he has to go right now. You gently explain to him that he's in a hospital right now and to try and get some sleep. Mr. Jones gets more and more upset because he has to get the fire going and let the cows out. You ask him the year and it's 1940 something. He throws a leg over the bedrail. The floor is awfully hard, by the way.

Meanwhile, Ms. Smith in Room 2 is in severe pain and needs her Dilaudid. How long are you going to make her wait?

Mr. Smith (no relation to Ms. Smith) in Room 3 has just gone into respiratory distress. His 02 sat is 84% and he's gasping. Better get him some oxygen. Mr. Smith has just become priority.

There's a new admission coming to Room 4, and they're on the phone waiting for you to take report.

So, what about Mr. Jones? Not going to give him that Seroquel so he can sleep tonight? Or do you let him fall out of bed on his noggin while he's on his way to build a nonexistent fire in the nonexistent fireplace?

Nunya, here are a few alternatives:

How about higher bed rails? No one (I hope) suggests that babies should be doped up to stop them from climbing around, we just put them in cribs.

Chemical restraint may seem less cruel then physical restraints, but that's only because we don't have to see it when someone is tied down within their own mind, and of corse we can tell ourselves that neuroleptics are 'medication.' If you ask people who have experienced both physical and chemical restraint which was worse, I'm sure that the consensus would be that the drugs are much more inhumane.

If we really can't find any alternative to drugging someone, how about using sedatives? Then we would have to be honest that we would be sedating people to control their problematic behavior, not medicating to treat symptoms. Sedatives have some serious problems too, but are much less dangerous than neuroleptics, especially for people who won't need to try to quit them.

If only drugging was being done simply for convenience, as you suggest may in some cases be true. By drugging people, rather than say, employing sitters, medicare and insurance may save money (and transfer a tidy profit to the pharma companies) and the costs are born by the patients who's health is further damaged and lives are shortened.

I think that this is yet another example of how being able to give people a pill and then dust one's hands of the problem is a huge impediment to making more difficult changes that would help people a lot more/ hurt them a lot less.

Nunya, even knowing, that based on these studies, your grandfather may have suffered more and died sooner, you still 'have no problem whatsoever' with him having been given neuroleptics? Really?

Maria, Just to clarify my point that appears hostile without intent to do so: there are many parents who are medicating children at younger ages, and I assume this is what you are addressing, is popular current culture. But remember in the end it is the prescibing doctor who writes the prescription. I have HOPE that a young doctor as yourself will not follow the path of some "old money" types, and set a new standard. I am pretty sure I know where you were coming from with your reply, but in this forum parental blame happens far too often for the drugging of American children, or suffice to say, I am a rare parent who fought a long battle against doctors who believe in medicating children. I'd like to apologize for my abrupt tone, which wasn't necessary for discussion.

Nunya, dementia, psychosis, Alzheimers, SZ are very similar at times, and based on experience with patients with all of those dx. "Sundowners" is a term still used in many psychiatric settings, and the alarm here is that these medications have a warning for use in these patients. I do though understand your frustration of wanting to keep your loved one from self-harm and seeing how the drug helped keep that from happening. It is a very complicated drug class to use, and should be prescribed in only the most severe cases, and certainly not broad use for the general population; which will happen soon enough, as antipsychotics replace anti depressants in the market place.

What about doping old folks up with opiates or marijuana and maybe a nice glass of wine or whiskey, drugs that people enjoy taking that cause euphoria. I was haldoled once, worst experience of my life. No human should have to endure such a thing especially someone who is delusional. Of course sitters are a better solution.

I agree that sedatives or even opiates would do the job with less danger in an understaffed nursing home. But don't forget, these may be generic and therefore not turn a profit for anyone and are therefore not pushed.

I also want to second the motion that we must never forget that the atypicals don't only kill people with dementia. They also kill people in their twenties and thirties, many of whom would have, or did, do fine on cheap old lithium. When it comes time to build a memorial in Washington - say a sculpture made in Vermont - they will be part of the plaque that says "in memory of our beloved innocents who died from prescription drugs." Our innocents need to be memorialized; all of them, in such a collective way.

What about the higher bed-rails alternative?

I mean, talk about an obvious solution staring at nursing homes in the face.

Yes, it may begin to be equivalent to a mini cage or sorts, but if we're concerned about the patient accidentally harming themselves, and don't want to dope them up on harmful and largely ineffective antipsychotics, and don't want to put them into 4-point restraints, this seems like something to consider......

anon- do you mean like an adult crib?

nunya- there are people who volunteer to be "sitters", if there is a need to keep a loved one safe, and off of a chemical restraint to do so--the family certainly does need to work, but there are other avenues to persue, before medication defense. as a parent deeply involved in the mental health system, and being in psych wards, you might want to know these are the same drugs used to zombie down patients there to keep them quiet as well. the dangerous side effects of these drugs can be questioned, "risk outweigh the benefit"? this is not a case of being placed on artificial life support--this is plain and simple--drugging up and elderly loved one to keep them in a drugged stupor until they die. i've been a "sitter" for my daughter for so many hours a day for years when she was drugged by these drugs and many times, alerted staff to her lack of movement and many times appearing not to be breathing. to see the horrors of antipsychotics used to "calm" people down, is something that is life-changing. I'd sit up 24 hrs a day if I had to keep my elderly loved one off of these medications and I am serious. That's just me and my opinion.

This all sounds too familiar. An elderly person with dementia or Alzheimer's has enough trouble making sense out of their unfamiliar surroundings and anti-psychotics just contribute to the confusion. My father in law went into a hospital emergency room for a UTI and at the first sign of confusion they ordered Haldol for him. When he got even more confused he started to be agitated at which point they tied him down to the bed and gave him more drugs. Between restraints and the drugs he got delerium. A man that could order off a menu the day before the hospital event, never recovered fully from the delerium. It just became another reason to give him other anti-psychotics for 6 months (Seroquel, Depokate). All because this started with a UTI! The hospital Psychiatrist said 6 months later the anti-psychotics were the problem because his executive function was so low...the confusion caused by the drugs pushed him over the edge to where NO ONE could take care of him. I think the solution is the rails on the bed as suggested and avoid the anti-psychotics with dementia patients. Even if it means they get treated as out-patients only.

neuroleptics are bad for everyone sometimes they are given in high doses to healthy people

What im i 2do they put my boyfriend on serquel hes never taken any pill in his life also hes only been clean off hard drugs 3or 4mths .could his mentel problems be just a part of withdrawl process.thanks signed alone and scared