The Independent newspaper, UK

January 9, 2009

'Liquid cosh' treatment kills dementia patients

By Jeremy Laurance, Health Editor

Sufferers in care homes 'kept quiet' to give staff an easier time, study finds

The lives of more than 100,000 people with Alzheimer's disease in Britain are at risk because of the toxic effects of the "liquid cosh", powerful sedatives widely used to suppress difficult behaviour, a study shows.

The drugs, called antipsychotics, were developed for patients with schizophrenia and similar mental illnesses but are also prescribed to control agitation, delusions and aggression which can occur in patients with Alzheimer's and other dementias. Researchers have now found that the death rate of patients dosed with the drugs was 70 per cent higher after three years, compared with those given placebo.

Experts have warned for more than a decade that antipsychotic drugs have been overused to keep patients quiet and give staff in care homes an easier life, to the detriment of the patients. But this is the first conclusive evidence of their lethal effects. The NHS watchdog, the National Institute for health and Clinical Excellence (Nice), recommends that the drugs should be used in severe cases only for short periods. But the average length of time they are prescribed for Alzheimer's is one to two years, the researchers say.

The Care Services minister, Phil Hope, said: "The inappropriate administration of medication is entirely unacceptable and this will be examined in the National Dementia Strategy which is due to be published shortly."

There are an estimated 700,000 people with dementia in the UK, most with Alzheimer's, of whom 150,000 are prescribed antipsychotics such as chlorpromazine, haloperidol and risperidone. Of these, 105,000 are "inappropriately" given the drugs in care homes, the researchers say. Previous studies have shown they have short-term benefits over 12 weeks but also side-effects including parkinsonism (shaking limbs), swelling, chest infections, decline in brain function and stroke.

Clive Ballard, of Kings College London, who led the research published in The Lancet Neurology, said: "It is essential to reduce the widespread long-term prescription of these drugs by using more non-drug treatments such as psychological therapies, and more research is urgently needed to establish more effective and safer treatments."

Dr Ballard, also director of research at the Alzheimer's Society, and colleagues randomly assigned 64 patients to continue with their antipsychotic medication for 12 months and compared them with 64 patients who were switched to a placebo. After one year, 70 per cent of the antipsychotic group were still alive compared with 77 per cent of those on placebo, but the gap widened over the longer term. By three years, 30 per cent of the antipsychotic group was still alive compared with 59 per cent of those on placebo.

The authors say: "Several studies have shown that psychological management can replace antipsychotic therapy without any appreciable worsening of neuropsychiatric symptoms."

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