The use and misuse of psychotropic prescribing for elderly psychiatric patients

The presenting problems and pre-admission diagnoses of 100 consecutive admissions to a geriatric psychiatry inpatient assessment unit were assessed in a retrospective survey and the use of psychotropic medication examined. Although post-admission diagnoses showed a high proportion of depressive illness amongst the patients, depression was infrequently diagnosed prior to admission and antidepressants infrequently used. The majority of these elderly patients were referred with a diagnosis of dementia and 'behaviour problems'. These were treated prior to admission with neuroleptics or benzodiazepines in line with prescribing habits in this population reported elsewhere in North America. Attention is drawn to the significant incidence of major depression in these patients and the excellent response to treatment, both with chemotherapy or with electrotherapy. Attention is also drawn to the pre-admission prescribing of psychotropic drugs which are likely to lead to problems when used in the elderly and likely to result in significant iatrogenic disorders.