Preferences of General Practitioners and Carers of Alzheimer Patients Regarding the Use of Neuroleptics for Behavioural Disorders in Alzheimer's Disease (pp. 209-225)
Authors: (M.J. Gonzalez Moneo, J. Espinàs Boquet, M. Pie Ocins, M. Simó Pi M, M.J. Megido Badia and D. Rivero)
Abstract: Introduction. Dementia management in primary care is a multidisciplinary process involving practitioners, nurses, social workers, and carers. Usual care is not only focused in the patient but in the carer, family and the neighbourhood around. When a behavioural anomaly occurs, the cause must always be investigated, and if possible, this should be modified. The symptomatic pharmacological treatment only begins when non-pharmacological methods have failed or due to the pressing nature of the situation.
Psychotic disorders are a frequent cause of medical emergencies, and cause a great deal of suffering to the person and the family. Neuroleptics are the only documented treatment for psychosis in dementia. In 2004, the warning issued by the FDA of the possible increased risk of cerebrovascular accidents in patients with dementia who received treatment with antipsychotics (risperidone) led us to review the prescriptions for
antipsychotics in our centre and we found that the prescription had not changed in 2/3 of patients.
The values, beliefs, feelings, that this disease provokes among all those involved could influence the continuity of the prescription of neuroleptics beyond the information available.
Aim. Determine the perceptions and experiences of carers and physicians regarding the use of neuroleptics for behavioural disorders in patients with Alzheimer.
Design. Qualitative method. Focal group with semi-structured interviews conducted in June 2005.
Location. Two urban health centres in Barcelona.
Participants. 8 main carers of patients with moderate-severe Alzheimer and 8 family and community medical professionals.
Method. Structural sample. Interviews conducted by the research team. Analysis of the content by two independent investigators using the Atlas-ti computer program.
Results. Quality of life and the negative feelings are the main areas related to behavioural disorders and the use of neuroleptics in the comments made by physicians and carers. Both groups consider the risk of treatment with neuroleptics acceptable because of the poor quality of life they imagine that behavioural disorders cause in the patient. In the case of physicians, they also consider the suffering of the carers. The group of physicians expressed the need for an action protocol and the convenience that the patient makes a living will with advance directives. Somme doctors, once caregiver is identified, just leave the door open to everything they should need . Specialists appear in the comments of both groups as a hard to access authority figure. Carers feel that the health of the patient and the administration or withdrawal of the neuroleptic is their responsibility. The carers have absolutely no doubt about the professional competence of all the doctors assigned to the patients. Some express confidence in their general practitioner when changing or withdrawing medication. Carers express the need for rest. Interdisciplinary teams (nurses and social workers included) consensus and ethics committees should play a role in such decisions.
Conclusion. Some non-clinical elements influence the prescription of neuroleptics, such as the feelings the symptoms provoke in physicians and carers. More considered and participated decisions could bring light in all those cases. We make some recommendations for the Practice.