Friday, 26 November 2010

Panorama - a narrow and unbalanced view

Pan-o-ram-a: a comprehensive presentation; a survey

"What Have the Drugs Done to Dad?"

I did not watch this programme at the time of its broadcast, nor was I aware that it was to be broadcast; I was only made aware of its existence by my manager, when (s)he reported that a few relatives had phoned the home, worried sick, in that their mum/dad were receiving antipsychotics and therefore believed that a drug induced premature death was imminent.

I have not long viewed same on BBC iPlayer.   I was alarmed by its almost sensational Daily Mail format, in that it only portrayed negative views of antipsychotic prescribing; Jeremy Vine stating: "...But perhaps worse of all. we know that 180,000 people with dementia are routinely being given powerful drugs, which in the  majority of cases harm them and which may actually shorten their life."

Cheryl Byrne reported on the sad case of her father who had been prescribed antipsychotics (while in hospital) and his apparent immediate decline.  It is a sad fact that hospitalisation (or care home admission) results in increased confusion, agitation and decline in mental status, as all that is familiar is suddenly taken away.  When our residents - with moderate to severe dementia - are hospitalised, upon their return, the decline is noticeable - but expected.  This is dementia.

Prof. Tim Kendall (RCoP) weighed in with his views of off licence prescribing, remarking that antipsychotics had a powerful sedative effect and were a chemical cosh, and should only be used after exhausting alternatives (I have never known antipsychotics being used as a first line treatment of aggression) and then only for a short while.

Prof. Sube Bannerjee (Inst. of Psychiatrists, King's College), put in his two pennyworth regarding antipsychotics shortening the lives of 1,800 dementia sufferers per year.  Costs, as in financial, were mentioned too - £80,000 million per year.  I wonder if this has anything to do with anything?

We visited the Spring Mount Care Home where residents were weaned of antipsychotics - as talking to people and interaction was a viable alternative. Methinks a little selective of residents here!  Could this be the only home where staff talk to their residents?  No!

Dementia is progressive whether receiving antipsychotics or not.

Before I continue, I should state that I am not an uncaring nurse who hides in a cupboard, drinking a secret bottle of vodka while reading Hello magazine; leaving the poorly paid and undervalued carers - which they are not - to deal with whatever the residents (who aren't drugged up to the eyeballs) care to throw at them.

Dementia has, and is, touching my personal life.  Ma, I can talk about - but the others still live.  I am not for unnecessary drug prescribing - I am against it!  But I am definitely for necessary drug prescribing!

Ted is one of the residents whose family phoned the home concerned about antipsychotics and possible premature death.  The move to our home is Ted's fifth!  His family were, in all cases, asked to find another home for Ted, due to serious 'Safeguarding Vulnerable Adults' issues.  There is no doubt that Ted is a vulnerable adult - but so were the quiet little old dears he punched on the face.  Ted is severely mentally infirm (yet very mobile) and to put it bluntly - there is not much going on upstairs.  He exists on auto-pilot, in that somewhere in the recesses of his mind - somethings strike him as not right.

It took four members of staff to prepare him for bed or assist him to rise in the morning - or change him after episodes of incontinence.  Ted would punch, kick, headbutt, shoulder, bite, slap, scratch, etc; staff did not take this personally, recognising Ted was not like this by choice, and realising that in his mind, he was defending himself.

Ted was prescribed antipsychotics and became calm - and dare I say it - HAPPY!  He was not heavily sedated, just carrying on before - but without the aggression; he ceased to be defensive during interventions, he slept well, ate well (admittedly while on the hoof) and didn't punch little old ladies on the head.

His psychogeriatrician succumbed to family pressure and halved his dose; Ted is no longer happy and the agitation and aggression is returning.  Observations are now required as Ted is a risk to others.  This is not fair on Ted or his fellow residents.

Ted is not alone in that he was given a certain level of peace and quality of life, that has now been taken away from him; others receiving the dreaded drugs are in the same boat.  Thanks Panorama!

As said in other posts, I would rather live five years of relative drug induced calm than exist for seven years in pure hell.  Wouldn't you?

Please note that I am reporting from my view of the world and accept that residents elsewhere may be over sedated.

Anna :o]

TO ANY DOC WHO MIGHT READ THIS AND WHO THINKS  I AM TOTALLY WRONG - PLEASE TELL ME.  TELL ME WHAT YOU SEE!  I AM NOT 'INTO' DRUGGING THE OLD DEARS IN AN EFFORT TO MANAGE BY SEDATION - AND IT DOESN'T HAPPEN IN OUR HOME.  PLEASE TELL ME IF YOU KNOW DIFFERENT.   I WANT TO LEARN!  CHEERS!

2 comments:

Anonymous said...

Whay about the suicides they are causing - have a look on youtube?

HyperCRYPTICal said...

Thanks for your comment Anonymous.

The above post related to the use of treating psychosis in the elderly. I realise that their use is controversial in this field, but I have only ever seen individuals benefit from their use, although I accept this is not always the case.

Antipsychotics are primarly used and prescribed to manage psychosis and suicidal ideation is sometimes a component of this.

Please visit:

http://onlinelibrary.wiley.com/doi/10.1002/pds.837/abstract

http;//ajp.psychiatryonline.org/cgi/content/abstract/158/9/1449

http;//www.psychiatrictimes.com/schizophrenia/content/article/10168/115394

One of the aims of prscribing antipsychotics is to hopefully reduce suicide attempts. Of course, this will not always be effective.

Anna ;o]