Use of psychotropic drugs in older people with mental illness

Aims: The aim of this study was to develop a clear understanding
of the psychotropic drugs being used in older people (equal to or
greater than 65 years) with mental illness being cared for by a
South West Yorkshire Mental (SWYMH) NHS Trust in Wakefield,
UK.
Methods: Psychotropic drugs are widely prescribed in older
people but compared with younger patients, relatively little has
been published on their use in older people in routine clinical
practice. This was a comprehensive survey of all patients equal
to or greater than 65 years of age being cared for by the South
West Yorkshire Mental Health NHS trust in Wakefield, England.
Information collected included demographic details, clinical information
about diagnosis and symptoms and detailed information
about medication. patients were seen in a variety of settings
including out-patients, acute wards, day hospitals and in the
community i.e. in patients’ own homes. If patients were attending
more thant one site or were being assessed by more than one
team they were only included once in the study. Clinical and
other information was collected by a research nurse from patients,
carers, medical and nursing staff, other health care professionals
and patients’ medical notes.
Results: In total 595 patients were included in the study and
of these 49.4% had dementia, 33.7% a mood disorder, 11%
schizophrenia or a related disorder and 5.9% anxiety and other
disorders. The age range was from 44−97 years with 31 patients
(5.2%) having early onset dementia. 20.4% of patients were not
taking any psychotropic drugs. Antipsychotics were the most
commonly prescribed drugs with 348 (58.7%) taking at least one
antipsychotic. 6.1% were taking two antipsychotics and 0.7% three
antipsychotics. In addition, 280 (47.2%) of patients were taking
an antidepressant. The most commonly prescribed antipsychotic
was risperidone and doses of risperidone were significantly higher
in patients with schizophrenia and paranoid disorders compared
with those with dementia and mood disorders (f = 4.41, p<0.002).
Conclusion: Psychotropic drugs are widely prescribed in older
people with the newer antipsychotics and antidepressants being
the two most commonly prescribed drugs. Risperidone was the
most commonly prescribed antipsychotic and paroxetine the most
commonly prescribed antidepressant. Both antipsychotics and
antidepressants were commonly used in patients whose primary
diagnosis was not schizophrenia or depression respectively. In
particular antipsychotics were prescribed more frequently for
patients with dementia with behavioural disturbance. However,
both antipsychotics and antidepressants were well tolerated but
approximately 7% of patients were taking two or more antipsychotics.