‘Agitated’ dementia patients may be in pain

ALArMInG numbers of people with learning disabilities are being given anti-psychotic medication to help manage their behaviour, according to a new campaign.

This is despite a report last year from the royal college of Psychiatrists that found for many of these patients the medication was ‘at best not helping them’. They also carry considerable potential risks, such as diabetes and shortened life expectancy.

There are times when anti-psychotics can help. But the problem is that many of these patients rely on alternative forms of communication to express their distress or pain: what might be termed ‘bad’ or ‘difficult’ behaviour may be their way of conveying vital informa- tion. even self harm (some people with learning disabilities bite their hand, for example) can be a result of being under-stimulated.

But too often, external, environmental issues are ignored and it’s assumed that the problems occur solely because of the disability.

Unfortunately the alternative to medication is costly and takes time, involving careful assessment by specialists and psychological interventions with the patient and carers. There simply aren’t the resources, so doctors reach for a chemical cosh instead.

The same happens with dementia. When I worked in this area, we would frequently be asked to see patients with ‘ challenging’ behaviour. nursing homes were keen for us to prescribe anti-psychotics so staff could get on with their jobs. But often a careful assessment would show an underlying problem — a tooth abscess, constipation or bed sores, or some other distressing or painful underlying problem.

A few years ago, research conducted by Kings college London, showed that painkillers were a very effective treatment for managing distress in dementia patients. Incredibly, their research showed that regular paracetamol was more effective in treating agitation and distress than anti-psychotics.

I put this into practice and was flabbergasted by the response in many of my patients — so much so that paracetamol became my first line of treatment for agitation in patients.