A brief followup to the rather lengthy post from a week or so ago regarding long-term care and medications.
Advertisements for pharmaceuticals is something we’ve all been exposed to for many years now. Not very long ago, pharmaceutical companies were prohibited from advertising directly to consumers. Now, of course, such advertisements are commonplace – everyone remembers the sparkly butterfly (Lunesta) and the bizarre Rozerem ads with the beaver and Abe Lincoln.
Some of the most popular, best-selling drugs are psychotropic medications. Three of the top ten drugs sold in 2011 were psychiatric medications: Seroquel and Abilify are second and third-generation anti-psychotics, respectively; Cymbalta is an antidepressant with some pain-control properties. All three are routinely used in the long-term care setting.
In this amusing link, http://www.buzzfeed.com/copyranter/insane-antipsychotic-drug-ads-of-yesteryear, the first few ads feature Thorazine (aka chlorpromazine). Thorazine is a member of the so-called phenothiazine class of medications, one of the most popular and venerable of the so-called “first generation” anti-psychotics, and of the first-generation neuroleptic drugs, probably second perhaps only to Haldol in terms of its fame.
The story that we’ve all been told is that these drugs were revolutionary because they eliminated the need for physical restraints in psychotic patients, allowing them to live normal lives. In truth, of course, these medications simply substitute one form of restraint (physical) for another form (chemical).
Many patients freely choose and prefer to be on these kinds of medications because they do not want to experience a recurrence of the problems they had without them (e.g., psychosis). However, patients with severe dementia are likely unable to consent to the administration of such drugs. The problem is that administering medications is a much more sanitized route to restraining your demented patients than use of physical restraints – it appears much more humane; but it doesn’t solve the problem that caused the agitation, violence, and behavior problems in the first place. Solving that problem takes effort.