Dementia

On May 16, 2014, the International Journal of Geriatric Psychiatry published an article by Deepa Archarya, PhD, et al. The article is titled Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia. Here are the authors’ conclusions: "Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management." In their Introduction section, the authors write: "Despite the high prevalence of these agitated and aggressive behaviors, there are currently no treatment options approved by US Food and Drug Administration for this indication. Nonpharmacological interventions, including environmental and behavioral modification, are difficult to implement in nursing home settings because of low staff-to-resident ratios." ...

Earlier this year, The American Society of Consultant Pharmacists published a report on the use of neuroleptic drugs in nursing homes. According to this report, 25% of nursing home residents receive neuroleptic drugs. In general, the Centers for Medicare and Medicaid Services (CMS) consider these prescriptions appropriate only if the recipient is psychotic. (Obviously we could discuss this at length, but let’s set that issue aside for now.) What CMS considers entirely inappropriate, however, is prescribing these products to residents with dementia as a way of controlling “difficult” behaviors such as wandering, being abusive, or resisting care. ...

In the old days, which I well remember, misbehavior in school was considered a disciplinary problem. This included not paying attention, fidgeting, not applying oneself to one’s work, talking, interrupting the teacher, etc., etc., etc… Then the APA decided that these various activities were really symptoms of a mental illness, and thereby created the ever-burgeoning market for Ritalin and other drugs which, we are falsely told, correct the “chemical imbalance” in these children’s brains. ...