DrMurdoch:
The most recent controversy with anti-psychotics is that they reduce life expectancy.
And my response is that in a person with little or no quality of life, and agitated to the point that the family wants to, or has to, institutionalize them, there seems to be little point in worrying about shortening life expectancy.
In fact, isn't it well known that we don't worry about "life expectancy" when giving morphine to a dying patient to palliate them?
And in so many demented patients the use of benzodiazepines just seem to help temporarily, but lead to a cascade of worsening confusion that is "counter" palliative. I doubt I am the only one to witness this phenomenon.
These psychotropic meds, as Roger calls them (I think that name is too general, so I am call them major tranquilizers) are useful as palliation, and once they're being used that way, it seems silly to assess life expectancy. The study by the US govt. was so, as my teenage daughter would say, "random" in it's conclusion that the drugs should be used in these diseases as a last resort, or NOT AT ALL in dementia patients.
That conclusion smacked of Wall Street-like FUD by a govt attempting to save money. Many of these patients are already institutionalized, and the meds are given there, at the gov't's expense. I cannot rationalize any other reason for their conclusions.
Incidentally, I often use these same meds at the end of life for other diagnoses, when the suffering by the patient is so great that they are literally panicked by imminent suffering and death. These meds really palliate, then, because too often the complaint by the patient is of pain, and they will be given narcotics in high enough doses that they become semi comatose. Instead, sometimes the patient is asking for help, but it's for their anxiety. Sometimes generic alprazolam is not the right answer in these dying patients, but something to curb their fear, (and not surprisingly, curbing the fear, allowing sleep often helps decrease their perception of pain). At the same time, these patients are often left alert by these meds, without changes in their personality, and will be able to interact with their families at a much higher cognitive level. Both the patient and the family appreciate this.
I AM NOT saying that dying people are crazy, only that they can be so emotionally charged that they stop making sense, or are living in a perpetual panic attack.
Now, I am giving opinion, as to the usefulness of these drugs. However using these meds as palliation is OFF LABEL use, and eventually, it seems, that is going to be against the law in the U.S.of A., the way things are going now.
There's just not enough money to go around, I'm afraid, and it's leading to this foolishness.