>So I wonder what we should use to keep em manageable?
I assume, Declan, your comment is rhetorical sarcasm?
Being serious for a moment I think this edict gives us problems and the patients more so.
As one who has to take atypical antipsychotics on a daily basis to stay among the so called rational humans called doctors and probably to remain human I feel large doses of empathy towards psychotic old people - some live in a nightmare world with audible anxieties and visible demons; they are living in homes full of strangers, little choice or understanding about who they are sat next to and having forgotten the way to communicate with the controllers or so called carers. You must have heard the plea "When can I go home" from a permanent resident who has no longer any home to go to, few relatives, and probably never a glimpse of outside let alone a breath of fresh air. Sleep is elusive and without the familiar landmarks of their lifelong bedtime routines they remain muddled, glimpses of reality bring painful insight, lost in the next second with the childlike fears and ramblings of a fragile disintegrating mind.
Whilst I agree over-sedation is not the answer, nor is undertreatment. When I am in that position someone stopping my antipsychotics would be condemning me to a living hell. They are "antipsyhcotic" because they restore some rationality and some humanity in selected patients. They should not all be made target of a blanket ban - the prescribing decision has to be patient focussed.
KT
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