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The two sides to antipsychotics

When the alternatives to antipsychotics are poetry, aromatherapy and dancing, you can understand why GPs take the path of least resistance, says Dr Livingstone

Yikes: a recent audit showed that more than a quarter of care home patients taking antipsychotics are being prescribed them inappropriately. Like you, I'm shocked by this figure; shocked, that is, that it's only 25 per cent. To be honest, the quality and quantity of care home repeat prescribing in general, and antipsychotics in particular, is shocking. And I take the point made in the audit that community pharmacists might just be the catalyst needed to sort it out.

As ever, though, there's another side to the story. GPs are well aware of the risks and adverse publicity around so-called ‘chemical coshes'. I've read loads of earnest, well-meaning articles describing non-drug approaches to behavioural problems in patients with dementia – including manoeuvres like reciting poetry, aromatherapy and dancing.

The problem is, by the time the staff have read The Lady of Shalott, sprayed the air full of Old Spice and resorted to pleading, ‘Mr Smith, why don't you put the matches down and join me in a paso doble?', you can understand why they might be on the phone begging me to prescribe enough tranquilliser to down an elephant.

The quality and quantity of care home repeat prescribing in general, and antipsychotics in particular, is shocking

Indeed, the last time I rang for an urgent mental health team review for some help resolving an attack of dodgy behaviour in the local granny stacker, I'd received a request from the community psychiatric nurse for a risperidone script almost before I'd put the phone down.

In other words, in real life, it ain't that simple. Stop those evil antipsychotics if you must, but if it all goes a bit demented, I'll make sure it's you they phone for advice. How's your dancing?

Dr Livingstone is a real-life GP lost somewhere in the NHS jungle. A reluctant part of a GP commissioning consortia, he offers his wry look at all things NHS. More from Dr Livingstone here.

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