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Clinical Manifestations.

Byron Creese1, Douglas Macfarlane1, Clive G Ballard2

  • 1Brunel University of London, London, United Kingdom.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Atypical antipsychotics are often prescribed off-label for dementia, despite risks. Improved education and shared decision-making are needed to ensure safer use and minimize harm for patients and their families.

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Area of Science:

  • Geriatric Medicine
  • Psychopharmacology
  • Qualitative Research

Background:

  • Atypical antipsychotics face prescribing restrictions globally, yet are used off-label.
  • Reasons for off-label atypical antipsychotic use in dementia are not well understood.
  • Safer prescribing necessitates examining the context of initiation and maintenance.

Purpose of the Study:

  • To explore patient, carer, and clinician perceptions of atypical antipsychotic risks and benefits.
  • To understand preferences for communicating side effect risks.
  • To identify factors influencing atypical antipsychotic prescribing in dementia care.

Main Methods:

  • Qualitative study employing semi-structured interviews with care home residents, relatives, and staff.
  • Focus group conducted with external healthcare professionals.
  • Framework analysis to identify key themes in prescribing and decision-making.

Main Results:

  • Care staff and relatives often lacked understanding of antipsychotic risks and inadequate side effect communication.
  • Participants favored person-centred care approaches.
  • Five key themes emerged: person-symptom interplay, decision-making dynamics, pre-prescription factors, information synthesis, and post-prescription monitoring.

Conclusions:

  • Enhanced education on atypical antipsychotic risks in dementia is crucial.
  • Involving relatives in shared decision-making, potentially with decision aids, is recommended.
  • Accessible guidance for monitoring antipsychotics post-prescription and incorporating qualitative research into pharmacotherapy guidelines is needed.